| Background and purpers:Gastric cancer is the most common malignant tumor all over the world. It is.about 10 percent of new tumors among gastric disease each year. The incidence accounted for 1/4 of the incidence of common malignant tumors in the world. It is about 10% of all patients who were died for this disease. Although some studies have shown that the overall incidence of gastric cancer has decreased worldwide in recent years. But the overall incidence of gastric cancer is still not optimistic. According to epidemiological survey stomach cancer is one of the common malignant tumors. Epidemiological survey shows that the total number of patients with gastric cancer of Asian countries accounted for about 70 percent of the global, among which over 40% came from China. In our country, its morbidity and mortality occupy the third of cancers. Despite the recent epidemiological datas find that the global incidence has decreased, but the treatment of the disease present situation still not optimistic in our country. The onset of gastric cancer has obvious regional differences. The incidence of coastal areas is higher than the incidence of inland areas. In addition, gastric cancer usually occurs in the elderly people. This disease has a gender tendency. The incidence of male is higher than incidence of female. Early gastric cancer performance is not obvious, relatively hidden. When clinical symptoms is found obviously, the stage is often in progress. It also increases the difficulty for surgery, and a lot of patients even lost treatment opportunity. Postoperative adjuvant therapy is faced with enormous challenges. For advanced gastric cancer recurrence rate is extremely high, A significant portion of patients relapse after comprehensive treatment. For the treatment of advanced gastric cancer doesn’t have much choice. Current clinical evidences and treatment experiences have shown that surgical removal of the lesions is the most important means for the treatment of gastric cancer. But postoperative tumor recurrence and metastasis is still a clinical problem that need to be solved, especially in advanced gastric cancer, the survival rate is lower. Although many countries and areas are all cleaning the lymph nodes according to naked eye, but many patients still died of recurrence and complications. Postoperative adjuvant treatment scheme is different in the world today, for example, some areas use pure radiation, some areas use radiation combined chemotherapy. The strategy of postoperative adjuvant treatment for gastric cancer is still controversy. This study was designed to investigate the efficacy and safty of postoperative chemoradiotherapy and chemotherapy alone in patients with advanced gastric cancer after surgery.Methods:This retrospectively study was designed to analyzed cases of gastric cancer patients who were treated in Anhui Medical University First Affiliated Hospital of Tumor Radiotherapy Department from July 1,2006 to January 31,2009. A total of 66 patients with Ⅱ-Ⅲb stage gsatric cancer were randomly assigned to postoperative chemoradiotherapy group(n=33) and chemotherapy alone group(n=33). All patients were followed-up by telephone, mail, E-mail, etc. The longest follow-up time was more than 5 years, the shortest follow-up time was about 8 months. We evaluate the survival conditions and the occurrence of adverse reactions of two kinds of treatments by the statistical methods (1 year survival rate,3 year survival rate and the 5-year survival rate, etc). Then we analyzed the factors affecting the treatment response.Results:66 patients were included in this study. The follow-up rate was 93.9%,The number of patients who had a minimum of 3-,5-year follow up time were 29,16 in the postoperative chemoradiotherapy group and 20,11 in the chemotherapy alone group. The 1-,3-, and 5-year survival rates for the chemoradiotherapy and chemotherapy group were 97%,87.9%,48.5% and 90.9%,60.6%,33.3%(x2=5.92, P=0.015), respectively. The 1-,3-, and 5-year recurrence-free survival rates were 78.8%, 66.7%,48.5% in the chemoradiotherapy group, and 69.7%,45.5%,33.3%in the chemotherapy group (χ2=7.41, P=0.006). The incidence of grade 3 hematological toxicity in the chemoradiotherapy group and chemotherapy group was 15.2% vs 9.1% (χ2=0.14, P=0.706),and grade 3 gastrointestinal toxicity was 18.2% vs 12.1%(x2=0.47, P=0.492). COX regression analysis showed that treatment methods, tumor location and tumor stage had a significant effect on the survival time. The incidence of grade 3 hematological toxicity for the chemoradiotherapy group and chemotherapy group was 15.2% vs 9.1%(Z=-0.296, P=0.767), and grade 3 gastrointestinal toxicity was 18.2% vs 12.1%(Z=-0.05, P=0.960).Conclusion:Compared with chemotherapy alone, postoperative chemoradiotherapy can improve survival of locally advanced gastric cancer, its toxic effects are tolerable. |
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