- 作者：Laurent Quero ; M.D. ; M.Sc.&lowast ; ; laurent.quero@sls.aphp.fr ; Zineb Bouchbika ; M.D.&lowast ; ; Honorine Kouto ; M.D. ; M.Sc.&lowast ; ; Valerie Baruch-Hennequin ; M.D.&lowast ; ; Jean-Marc Gornet ; M.D.&dagger ; ; Nicolas Munoz ; M.D.&Dagger ; ; Isabelle Cojean-Zelek ; M.D.§ ; ; Remi Houdart ; M.D.鈥?/sup> ; Yves Panis ; M.D. ; Ph.D.¶ ; ; Patrice Valleur ; M.D.# ; Thomas Aparicio ; M.D. ; Ph.D.&lowast ; &lowast ; ; Claude Maylin ; M.D.&lowast ; ; Christophe Hennequin ; M.D. ; Ph.D.&lowast ;
- 关键词：Gastric cancer ; Postoperative ; Cisplatin ; Chemoradiotherapy ; Conformal
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 期刊代码：136_03603016
- 类别：med
- 出版时间：1 June, 2012
- 卷：83
- 期：2
- 页码：574-580
- 文件大小：299 K
Purpose
To analyze the efficacy, toxicity, and pattern of relapse after adjuvant cisplatin-based chemotherapy followed by three-dimensional irradiation and concomitant LV5FU2 chemotherapy (high-dose leucovorin and 5-fluorouracil bolus plus continuous infusion) in the treatment of completely resected high-risk gastric cancer.Methods and Materials
This was a retrospective analysis of 52 patients with high-risk gastric cancer initially treated by total/partial gastrectomy and lymphadenectomy between January 2002 and June 2007. Median age was 54 years (range, 36-75 years). Postoperative treatment consisted of 5-fluorouracil and cisplatin chemotherapy. Adjuvant chemotherapy was followed by three-dimensional conformal radiotherapy in the tumor bed and regional lymph nodes at 4500 cGy/25 fractions in association with concomitant chemotherapy. Concomitant chemotherapy consisted of a 2-h infusion of leucovorin (200 mg/m虏) followed by a bolus of 5-fluorouracil (400 mg/m虏) and then a 44-h continuous infusion of 5-fluorouracil (2400-3600 mg/m虏) given every 14 days, for three cycles (LV5FU2 protocol).
Results
Five-year overall and disease-free survival were 50%and 48%, respectively. Distant metastases and peritoneal spread were the most frequent sites of relapse (37%each). After multivariate analysis, only pathologic nodal status was significantly associated with disease-free and overall survival. Acute toxicities were essentially gastrointestinal and hematologic. One myocardial infarction and one pulmonary embolism were also reported. Eighteen patients had a radiotherapy program interruption because of acute toxicity. All patients but 2 have completed radiotherapy.
Conclusion
Postoperative cisplatin-based chemotherapy followed by conformal radiotherapy in association with concurrent 5-fluorouracil seemed to be feasible and resulted in successful locoregional control.