摘要目的 观察局部晚期胃癌术后卡培他滨同期调强放疗(IMRT)中,卡培他滨的最大耐受剂量(MTD)和剂量限制性毒性(DLT).方法 入组标准为接受根治术(R0切除)或非根治术(R1、R2切除),术后病理证实为TxN(+)M0期的近端或远端胃癌患者.共18例患者入组,其中R0术12例、R1术2例、R2术4例.放疗采用IMRT技术,R0术后总剂量45 Gy,1.8 Gy/次,5次/周.R1或R2术后,对有肉眼或镜下肿瘤残存部位进行局部加量10.8 Gy分6次.卡培他滨剂量水平分5级,分别为625 mg/m2(Ⅰ级)、700 mg/m2(Ⅱ级)、800 mg/m2(Ⅲ级)、900 mg/m2(Ⅳ级)、1000 mg/m2(Ⅴ级),口服2次/d.结果 最常见1～3级的不良反应为白细胞减少(89％)、食欲下降(83％)和恶心(83％).Ⅰ级中1例出现3级食欲下降、恶心和4级呕吐.Ⅱ级中1例出现3级食欲下降和恶心.Ⅲ级时2例分别出现4级中性粒细胞减少和3级放射性食管炎.结论 局部晚期胃癌术后卡培他滨同期IMRT的MTD为800 mg/m2,2次/d,DLT为恶心、呕吐、食欲下降、中性粒细胞减少和放射性食管炎.

abstractsObjective To determine the maximum-tolerated dose (MTD) and dose-limiting toxicities (DLTs) of capecitabine during postoperative concurrent capecitabine and intensity-modulated radiotherapy (IMRT) for locally advanced gastric cancer.Methods The patients,who had TxN (+) M0gastroesophageal or gastric adenocarcinoma after radical surgery with negative margins (R0) or non-radical surgery with microscopically positive margins (R1) or macroscopically positive margins (R2),were included in the study.A total of 18 patients (R0 12;R1 2;R2 4) were recruited.IMRT (45 Gy at 1.8 Gy/fraction)was delivered to the tumor bed (T4b only),anastomosis site,duodenal stump,and regional lymph nodes days per week for 5 weeks.Patients with R1 or R2 resection received additional radiation (10.8 Gy/6fractions) to the microscopically or macroscopically positive margins.During IMRT,capecitabine was orally administered twice daily at a dose of 625 mg/m2 (level Ⅰ,n =6),700 mg/m2 (level Ⅱ,n =6),800mg/m2(level Ⅲ,n=6),900 mg/m2(level Ⅳ,n=0),and 1000 mg/m2(level Ⅴ,n=0).DLT was defined as grade 3 or 4 hematologic and non-hematologic toxicities.Results Grade 1-3 leukopenia (89％),anorexia (83％),and nausea (83％) were the most common toxicities.Grade 3 anorexia/nausea and grade 4 vomiting occurred in one patient at dose level Ⅰ.Grade 3 anorexia and nausea occurred in one patient at dose level Ⅱ.One patient at dose level Ⅲ developed grade 4 neutropenia,while another patient at dose level Ⅲ developed grade 3 radiation esophagitis.Conclusions During postoperative concurrent capecitabine and IMRT for locally advanced gastric cancer,the MTD of capecitabine is 800 mg/m2 twice daily,and the DLTs are nausea,vomiting,anorexia,neutropenia,and radiation esophagitis.