Clinical Effect Of Chemoradiotherapy Compared With Chemotherapy Alone For Locally Advanced Gastric Cancer With D2 Lymph Node Dissection

Objective:To compare the therapeutic effects and adverse reaction of concurrent Chemoradiotherapy with chemotherapy alone for local advanced gastric cancer following D2 lymph node dissection,and provide references for the clinical selection of postoperative adjuvant therapy for gastric cancer.Methods:64 patients with advanced gastric cancer who underwent R0 gastric resection and D2 Lymph node dissection were included.They were treated in the Affiliated Anqing Hospital of Anhui Medical University from 2012~09~01 to 2014~08~31.The patients were divided into experimental group(n=33)and control group(n=31),according to the different therapetic schmes.After radical gastrectomy,the experimental group patients received radiotherapy concurrent(45Gy/25f/5w)with capecitabine chemotherapy(825 mg/m2,2 times/day,and then followed by 4 cycles of XELOX chemotherapy(oxaliplatin:130 mg/m~2,1day;Capecitabine 1000mg/m~2,orally,2times/day,1~14 days,7~day rest;Repeat every 3 weeks);the control group only received 6 cycles of XELOX chemotherapy.The 1,2,3 years disease~free survival rates,1,2,3 years overall survival rates and toxicity were observed and analyzed.Result:The follow~up deadline was 2017~11~30.The follow-up time was 6.5months to 50 months(median follow-up time was 32 months).There were two patients loss to follow-up,the follow-up rate was 96.8%.At the end of the follow-up,9patients of experimental group survived,and only 7 patients in the control group survived.The 1,2,3~year overall survival rates for the experimental and control group were 90.9%、75.8%、54.5%and 83.95%、54.85%、29.0%(X~2=2.424,P=0.119).The1,2,3~year disease~free survival rates were 87.9%、69.7%、45.5%in the experimental group,and 83.95%、54.85%、29.0%in thecontrol group(X~2=1.644,P=0.200).Subgroup analysis of positive pathologic lymph nodes patients,there was a statistically significant difference in 1,2,3~year overall survival rates(x~2=5.140,P=0.023),and disease-free survival rates(X~2=4.833,P=0.028)between the two groups.Cox regression analysis showed that lymph node metastasis was an important factor influencing the survival time of patients(HR=0.421,95%CI 0.189 to 0.937,P=0.034).The incidence of adverse reactions in the two groups was similar,including blood toxicity,gastrointestinal toxicity and neurotoxicity.The incidence of grade 3 to 4 adverse reactions was 33.3%(11/33)in the experimental group and 25.8%(8/31)in the control group.Grade 4 neutropenia occuerred in one patient(3.0%),however,there was no fever caused by the absence of granulocytes.Conclusion:Compared with chemotherapy alone,postoperative chemoradiotherapy can improve survival of patients who with lymph node~positive gastric cancer,and the toxic effects are tolerable.