摘要目的：观察局部晚期胃癌患者术前同步放化疗后的手术切除率、病理缓解率及不良反应发生率，探索最佳的新辅助放化疗方案。方法2013—2014年间本院初治的潜在可切除或不可切除的局部晚期胃癌患者11例入组，临床分期为cT4N0M0或TxN1?3M0（AJCC第7版），病理为腺癌。放疗采用IMRT技术，总剂量40～50 Gy分22～25次4～5周完成。同步化疗采用替吉奥或卡培他滨或紫杉醇联合卡铂的方案。同步放化疗结束后4～8周手术。结果接受R0手术者9例，R2手术1例，1例因术中发现腹膜种植转移仅行剖腹探查术。术后病理提示重度反应4例，其中包括pCR 1例。共完成放疗10例、化疗8例。3级不良反应主要见于恶心（3例）、呕吐（2例）和食欲下降（2例），无4级不良反应。结论术前同步放化疗对局部晚期胃癌患者的肿瘤降期率和R0切除率疗效较好，不良反应可耐受。

abstractsObjective The aim of this study was to investigate whether the addition of neoadjuvant chemoradiotherapy ( NACRT ) to surgery can improve outcomes better than neoadjuvant chemotherapy in terms of rate of R0 resection, pathological complete response ( pCR ) and side effects. Methods This exploratory study included primary gastric adenocarcinoma patients staged as clinical T4N0 or anyTN1-3. Intensity modulated radiotherapy was delivered of 40 to 50 Gy in 22 to 25 fractions,5 days/week.Concurrent chemotherapy regimens included S-1 or Capecitabine or a combination of Paclitaxel plus Carboplatin.Results Eleven eligible patients were enrolled. R0 and R2 resections were performed in 9 ( 9/11) and 1 patients, respectively.Peritoneal metastasis was found in 1 case during exploratory laparotomy.The pCR was observed in 1 patient with R0 resection ( 1/10 ) . Ten cases completed radiotherapy and 8 cases completed chemotherapy. Nausea ( 3/11 ) , vomit ( 2/11 ) and anorexia ( 2/11 ) were the most common Grade 3 toxicities. Conclusions NACRT showed an acceptable toxicity and promising activity in locally advanced gastric adenocarcinoma.