局部晚期胃癌根治术后放射治疗研究进展

张佳佳　王鑫　金晶



局部晚期胃癌根治术后放射治疗研究进展

张佳佳王鑫金晶

摘要术后同步放化疗是局部晚期胃癌根治术后重要的辅助治疗手段。对于局部晚期胃癌根治术后淋巴结清扫小于D2范围者，术后同步放化疗可以提高局部和长期的疗效，为指南推荐的术后辅助治疗标准方案。D2术后是否需同步放化疗仍存在争议。来自亚洲的3项Ⅲ期随机分组临床试验表明D2术后同步放化疗安全可行并可能使部分患者获益；术后同步放化疗的作用仍需设计良好、检验效率充分的随机对照临床试验进一步明确。下一步研究的重点将侧重于筛选可从同步放化疗中获益的局部区域复发高危人群、进一步优化放疗靶区范围、探索应用新的放疗技术等方面。

关键词局部晚期胃癌D2清扫术放射治疗研究进展

Research progress on postoperative radiation therapy in locally advanced gastric adenocarcinoma

Jiajia ZHANG, Xin WANG, Jing JIN

Correspondence to: Jing JIN; E-mail: jingjin1025@163.com

Department of Radiation Oncology, Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

Abstract Chemoradiotherapy is an important part in the adjuvant regimen for locally advanced gastric cancer after radical resection. Adjuvant chemoradiotherapy has demonstrated a clear local control and survival advantage for locally advanced patients with less than D2 lymph node dissection. Thus, chemoradiotherapy is recommended as standard of care in the postoperative setting. However, the role of radiotherapy for patients with more extensive D2 lymph node dissections remains controversial. Three phase III randomized clinical trials in Asia show that adjuvant chemoradiotherapy after D2 dissection is safe and feasible and may benefit certain groups of patients. The benefit of radiotherapy in the case of more extensive surgery still warrants well-designed, fully powered randomized controlled clinical trials for verification. More studies are needed to focus on the identification of patient subgroups that are at high risk for locoregional failure and may benefit from adjuvant chemoradiotherapy. Further optimization of target volume in the radiotherapy and exploration of new modalities of radiation techniques are also necessary.

Keywords:locally advanced gastric adenocarcinoma, D2 lymph node dissection, radiotherapy, research progress

胃癌是最常见的消化道肿瘤之一。据2015年最新发布的世界癌症数据，在男性常见肿瘤中，胃癌位居第4位，死亡率居于第3位；胃癌位居女性常见肿瘤中第5位，死亡率居于第5位，在亚洲国家尤其高发［1］。根治性手术切除是其唯一的治愈手段，但对于局部晚期胃癌，单纯手术疗效较差、复发率较高，需要多学科的综合治疗。大量研究表明，术后辅助治疗可降低局部区域复发率、改善患者生存。对于可手术切除的胃癌患者，术后局部区域复发率不同文献报道约20%～40%，在二次手术及尸检患者中，局部复发率可高达80%～93%，占所有复发患者的80%～85%，局部区域复发为术后失败的主要模式［2-5］。……