放射治疗在胃癌全程管理中的现状与挑战

doi:10.19401/j.cnki.1007-3639.2022.07.001

中国癌症杂志 ›› 2022, Vol. 32 ›› Issue (7): 581-587.doi: 10.19401/j.cnki.1007-3639.2022.07.001

放射治疗在胃癌全程管理中的现状与挑战

蔡钢()(), 王舒蓓, 陈佳艺()()

上海交通大学医学院附属瑞金医院放射治疗科,上海 200025

收稿日期:2022-06-02 出版日期:2022-07-30 发布日期:2022-08-09
通信作者: 陈佳艺 E-mail:caigangcg@163.com;chenjiayi0188@aliyun.com
作者简介:蔡钢（ORCID: 0000-0001-8071-4422）,博士,副主任医师,E-mail: caigangcg@163.com。
陈佳艺,上海交通大学医学院附属瑞金医院放射治疗科主任、主任医师,上海交通大学肿瘤学博士研究生导师。长期致力于肿瘤放疗的临床和转化型研究,尤其擅长乳腺癌、胃肠道肿瘤、恶性淋巴瘤等的放疗和综合治疗,是国内最早开展粒子治疗研究的学者之一。长期从事上海市放疗质控中心专家组的工作,对数字化和信息化管理及质控管理有深入的研究。目前担任上海市医学会肿瘤放射治疗专业委员会候任主任委员,中国抗癌协会整合肿瘤心脏病学专业委员会副主任委员,中国临床肿瘤学会神经系统肿瘤专家委员会副主任委员,中国临床肿瘤学会乳腺癌专家委员会常委,中国临床肿瘤学会肿瘤放射治疗专家委员会常委。曾获得2018年度上海市三八红旗手,2019年度上海市最美女医师,2019年度上海市巾帼建功标兵。“中国临床肿瘤学会乳腺癌诊疗指南”放疗部分执笔人,并参与编写国内多个乳腺癌放疗指南。以项目负责人身份先后承担国家自然科学基金面上项目2项,科技部重大项目子课题1项,省部级课题2项,申康“三年行动计划”项目2项,上海市局级课题1项。以第一作者或通信作者在国内权威、核心和SCI收录期刊上发表论文70余篇。

The current data and challenge of radiotherapy in the case management of gastric cancer

CAI Gang()(), WANG Shubei, CHEN Jiayi()()

Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received:2022-06-02 Published:2022-07-30 Online:2022-08-09
Contact: CHEN Jiayi E-mail:caigangcg@163.com;chenjiayi0188@aliyun.com

摘要/Abstract

摘要：

胃癌是常见的消化道恶性肿瘤之一。放疗是胃癌综合治疗的重要手段之一。近年来,包括放疗在内的局部进展期胃癌的围手术期治疗的探索不断取得突破,这些疗法对胃癌患者生存的积极影响也越来越明显。近年来在胃癌的新辅助放疗、辅助放疗、进展期肿瘤放疗及免疫联合放疗领域均有新的研究成果。本文深入分析国内外的相关研究进展,系统阐述放疗在胃癌治疗中的应用现状与进展。

关键词: 胃癌, 放射治疗, 新辅助治疗, 辅助治疗

Abstract:

Gastric cancer is one of the common malignant tumors of digestive tract. Radiotherapy is one of the important comprehensive treatment modalities for patients with gastric cancer. In recent years, there have been breakthroughs in perioperative treatment for locally advanced gastric cancer by radiotherapy and other treatments. The positive impact of such therapies on survival in patients with gastric cancer has become clearer over time. In recent years, new achievements have been made in the fields of neoadjuvant radiotherapy, adjuvant radiotherapy, advanced tumor radiotherapy and combined immunoradiotherapy for gastric cancer. This article analyzed the relevant research progress at home and abroad, and systematically expounded the current status and progress of radiotherapy in the treatment of gastric cancer.

Key words: Gastric cancer, Radiotherapy, Neoadjuvant therapy, Adjuvant therapy

中图分类号:

R735.2

蔡钢, 王舒蓓, 陈佳艺. 放射治疗在胃癌全程管理中的现状与挑战[J]. 中国癌症杂志, 2022, 32(7): 581-587.

CAI Gang, WANG Shubei, CHEN Jiayi. The current data and challenge of radiotherapy in the case management of gastric cancer[J]. China Oncology, 2022, 32(7): 581-587.

图/表 2

表1

表2

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Study	Publication year	Country/region	Study design	Tumor site	Group	R0 resection rate	pCR rate	OS
CROSS^[3]	2012	Netherlands	Phase Ⅲ randomized control	Esophagus/esophagogastric junction	Surgery (n=188); Carboplatin+taxol+radiotherapy+surgery (n=178)	69%; 92%	-; 29%	24.0 months (median OS); 49.4 months (median OS)
POET^[4]	2009	Germany	Phase Ⅲ randomized control	Esophagus/gastric cardia	Cisplatin+FU/LV (n=59); Cisplatin+FU/LV+radiotherapy (concurrent chemotherapy: cisplatin+etoposide) (n=60)	70%; 72%	2%; 16%	24.4% (5-year OS rate); 39.5% (5-year OS rate)
NEO-AEGIS	2021 (preliminary result)	International	Phase Ⅲ randomized control	Esophagus/esophagogastric junction	ECF/ECX/EOF/EOX, FLOT (n=184); Carboplatin+taxol+radiotherapy (n=178)	82%; 95%	5%; 16%	56% (3-year OS rate); 57% (3-year OS rate)
TOPGEAR^[5]	2017 (midterm result)	Europe, Canada	Phase Ⅲ randomized control	Esophagogastric junction/gastric	ECF/ECX+surgery+ECF/ECX (n=60); ECF/ECX+radiotherapy+surgery+ECF/ECX (n=60)
PREACT	Ongoing	China	Phase Ⅲ randomized control	Esophagogastric junction/gastric	SOX+chemoradiotherapy+SOX+surgery+SOX; SOX+surgery+SOX
CRITICS Ⅱ	Ongoing	Netherlands	Phase Ⅲ randomized control	Gastric	DOC+surgery; DOC+chemoradiotherapy+surgery; Chemoradiotherapy+surgery
ESOPEC	Ongoing	Germany	Phase Ⅲ randomized control	Gastric	FLOT+surgery+FOLT; Chemoradiotherapy+surgery
5010	Ongoing	China	Phase Ⅲ randomized control	Gastric	Radiotherapy+XELOX+surgery+XELOX; XELOX+surgery+XELOX

Study	Publication year	Country/region	Study design	Group	Surgical method	DFS	OS
INT-0116^[10]	2012	North America	Phase Ⅱ randomized control	Surgery (n=277); Surgery+radiotherapy+FU/LV (n=282)	D1 or D2	19 months (median DFS); 27 months (median DFS)	27 months (median OS); 35 months (median OS)
ARTIST^[13]	2012	Korea	Phase Ⅲ randomized control	Surgery+XP (n=228); Surgery+XP+radiotherapy (n=230)	D2	74.2% (3-year DFS rate); 78.2% (3-year DFS rate)	73% (5-year OS rate); 75% (5-year OS rate)
ARTIST Ⅱ^[15]	2021	Korea	Phase Ⅲ randomized control	Surgery+S-1 (n=182); Surgery+SOX (n=181); Surgery+SOX+radiotherapy (n=183)	D2	64.8% (3-year DFS rate); 74.3% (3-year DFS rate); 72.8% (3-year DFS rate)
CRITICS^[17]	2018	Netherlands	Phase Ⅲ randomized control	Chemotherapy+surgery+chemotherapy (n=393); Chemotherapy+surgery+chemoradiotherapy (n=395)	D1 or above		ITT: no difference; PP: 57.9% and 45.5% (5-year OS rate)

放射治疗在胃癌全程管理中的现状与挑战

The current data and challenge of radiotherapy in the case management of gastric cancer

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