多西他赛联合顺铂、氟尿嘧啶和亚叶酸的新辅助化疗方案治疗不能切除进展期胃癌的疗效观察  

The combination of docetaxel,cisplatin,fluorouracil and leucovorin(CF) as neoadjuvant chemotherapy for the treatment of non-resectable advanced gastric cancer

作　　者：杨喆[1] 王治国[1] 

机构地区：[1]交通大学附属第六人民医院普外科,上海200233

出　　处：《中国癌症杂志》2006年第5期346-350,共5页China Oncology

摘　　要：背景与目的：手术治疗目前仍是无远处转移胃癌的标准治疗方法，但大多数胃癌患者就诊时已经是进展期而不宜手术。新辅助化疗足指在外科手术术前给予化疗，其目的之一是通过缩小原发肿瘤使之可以进行手术切除，最终延长生存期。本临床试验目的在于研究多西他赛（商品名：泰索帝）联合顺铂、氟尿嘧啶和亚叶酸给药方案术前进行诱导化疗对不能切除的进展期胃癌的临床疗效及毒副反应。方法：入组患者均为本院2003年6月-2005年6月收治的12例晚期胃癌而无法行根治手术者。术前的新辅助化疗方案为：泰索帝75mg／m^2、顺铂75mg/m^2。第1天；氟尿嘧啶500mg／m^2、亚叶酸200mg／m^2第1～5天，每三周为一个周期，共两个周期。观察新辅助化疗后原发病灶的变化情况并观察用药后的毒副反应。结果：新辅助化疗后9例患者获得肿瘤减期，疗程结束后4～6周8例进行根治性手术切除。临床完全缓解（CR）1例，部分缓解（PR）8例，无变化（NC）3例，进展（PD）0例，有效率75％（9／12），腹水消退率63.6％（7／11）。组织学效果：轻度有效3例，中度有效4例，显著有效1例。副反应主要为骨髓抑制、腹泻、恶心呕吐、脱发，经对症以及营养支持治疗后均能缓解。结论：多西他赛加顺铂、氟尿嘧啶及亚叶酸的新辅助化疗方案在高度进展期胃癌的治疗中，对提高手术切除率疗效显著，耐受性良好。Background and purpose： Radical surgery remains the main treatment for patients with resectable gastric cancer. However, the majority of patients have advanced gastric cancer with either extensive invasion of tumor into the adjacent organs, lymph nodes or metastases when diagnosed. The advantage of neoadjuvant chemotherapy prior to surgery includes the shrinking of the cancer so that surgery becomes feasible for the patients with inoperable cancer and ultimately improve their long-term outcome. We conducted a clinical trial to evaluate the efficacy and toxicity of docetaxel（TAX）, cisplatin（CDDP） and fluorouraeil（5-FU） plus leucovorin（CF） as the neoadjuvant chemotherapy in the treatment of non-resectable advanced gastric cancer. Methods： From June 2003 to June 2005, 12 patients with non-resectable advanced gastric cancer were treated with docetaxel/cisplatin/5-FU/CF before operation. Neoadjuvant chemotherapy regimens consisted of doeetaxel（D）, 75mg/m^2（ days 1）, cisplatin （C）, 75mg/m^2（ days 1）, fluorouracil（F）, 500mg/m^2（ days 1 to 5） plus leuco- vorin （ CF）, 200mg/m^2（ days 1 to 5） and were adnlinistered every 3 weeks for 2 - 3 cycles before operation. The immediate response and toxicity were documented tot each patient. Results： 9 of the 12 patients were downstaged and g were radically operated 4-6 weeks after the end of the neoadjuvant chemotherapy. The overall response rate was 75% with 8.3% CR and 66.7% PR, 25% NC, and the ascites disappeared in 63.6% （7/11）. Pathological complete response was found in 1 case. Histopathogical responses were scaled as mild, moderate and marked in 3, 4 and 1 cases, respectively. The most common toxicities were bone marrow suppression, nausea, vomiting, alopecia and heptoses. The toxicities were recoverable after symptomatic treatment. Conclusions： The combination of docetaxel , cisplatin , fluorouracil plus leucovorin （CF） is a very effective artd well-tolerated regimen as neoadjvant chemotherapy for the patients

关 键 词：新辅助化疗 胃癌 多西他赛 顺铂 氟尿嘧啶 亚叶酸 晚期 

分 类 号：R735.2[医药卫生—肿瘤] R730.53[医药卫生—临床医学]