Efficacy and prognosis of palliative radiotherapy for advanced gastric cancer / 国际肿瘤学杂志

ABSTRACT

Objective:To investigate the efficacy and prognostic factors of palliative radiotherapy for advanced gastric cancer.Methods:From January 2013 to December 2018, the clinical data of 390 patients with advanced gastric cancer in the Cancer Center of Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were collected. Patients were divided into two groups—combined chemoradiotherapy group ( n=95) and chemotherapy alone group ( n=295) according to the treatment method. Patients were followed up by outpatient reviews, phone calls or text messages at regular intervals. The clinical efficacy and prognostic factors of palliative radiotherapy in patients with advanced gastric cancer were retrospectively analyzed. Results:The median survival time and the 6-month, 1-year, 2-year survival rates of combined chemoradiotherapy group and chemotherapy alone group were respectively 28.07 months versus 11.27 months, 89.0% versus 69.0%, 68.0% versus 40.0%, 51.0% versus 15.0%. The survival rate of the combined chemoradiotherapy group was significantly higher than that of the chemotherapy alone group ( χ2=27.400, P<0.001). The median survival time of the combined chemoradiotherapy group was significantly longer than that of chemotherapy alone group in both 289 first-time diagnosed patients ( χ2=23.681, P<0.001) and 101 recurrent gastric cancer patients ( χ2=5.164, P=0.023), with median survival time being 28.07 months versus 11.47 months and 16.37 months versus 10.53 months respectively. Chemotherapy regimen before radiotherapy ( χ2=7.019, P=0.030), disease control before radiotherapy ( χ2=4.689, P=0.030), Eastern Cooperative Oncology Group (ECOG) score before radiotherapy ( χ2=8.529, P=0.014) and radiotherapy area ( χ2=4.763, P=0.029) were factors influencing the prognosis of patients with advanced gastric cancer undergoing palliative radiotherapy. Multivariate analysis showed that ECOG score ( HR=2.252, 95% CI 1.288-3.935, P=0.004) and disease control before radiotherapy ( HR=2.604, 95% CI 1.183-5.730, P=0.017) were independent prognostic factors. Conclusion:The efficacy of combined chemoradio-therapy is significantly better than chemotherapy alone in both first-time diagnosed and recurrent advanced gastric cancer. Chemotherapy regimen before radiotherapy, disease control before radiotherapy, ECOG score before radiotherapy and radiotherapy area are factors influencing the prognosis of patients with advanced gastric cancer undergoing palliative radiotherapy. ECOG score and disease control before radiotherapy are independent prognostic factors.