奥沙利铂联合氟尿嘧啶、亚叶酸钙不同给药途径治疗顺铂或卡铂耐药肿瘤近期疗效观察

Short-term Effect of Oxaliplatin Combined with 5-Fluorouracil and Calcium Folinate by Different Pathway for DDP or CBP-resistant Carcinoma

[目的]观察奥沙利铂(Oxaliplatin,OXA)联合5-氟尿嘧啶(5-Fu)及亚叶酸钙(CF)不同给药途径治疗对顺铂(DDP)或卡铂(CBP)耐药肿瘤的近期疗效及不良反应.[方法]选择对DDP或CBP耐药的肿瘤73例,随机分为A、B两组,其中A组36例,OXA 100 mg/m2,第1天经动脉灌注,5-Fu每天600mg/m2,CF每天200 mg/m2,第1天经动脉灌注,第2～5天经中央静脉持续滴注(CF 2小时滴完,推注5-Fu 200 mg/m2,后继以5-Fu 400 mg/m2持续22小时滴注),每21天为1个周期;B组37例,药物经中央静脉持续滴注,药物、剂量及用药天数同A组.[结果]化疗第6个周期末,A组PR 20例,SD 8例,PD 8例,有效率为55.6%;B组PR 7例,SD 15例,PD 15例,有效率为19.0%.两组的有效率比较有统计学差异(P＜0.01).A组的肿瘤控制率(OTGCR,CR+PR+SD)为77.8%,B组为59.5%,两组比较无统计学差异(P＞0.05).结、直肠癌盆腔或肝转移的有效率分别达44.4%和45.0%,胃癌肝转移的有效率33.3%,肺癌有效率25.0%,胰腺癌肝转移有效率25.0%,胆囊癌肝转移无效.A组的不良反应除手足麻木明显少于B组外,其它不良反应无差别.[结论]OXA联合5-Fu、CF治疗对DDP或CBP耐药的部分肿瘤有效,不良反应轻.经动脉用药较经静脉用药明显提高近期缓解率,且可以减少外周感觉神经异常的发生.

To evaluate the short-term effect and side effects of oxaliplatin(OXA) combined with 5-fluorouracil(5-Fu) and calcium folinate(CF) by different pathways for DDP or CBP-resistant carcinoma. Seventy-three cases with malignancy resisting to DDP or CBP were divided randomly into group A and group B. Thirty-six cases in group A were treated with OXA 100 mg/m2, 5-Fu 600 mg/m2,CF 200 mg/m2,on d1, and the medicines were given by arterial injection. On d2~5, CF 200 mg/(m2·d) as a 2-hour infusion followed by bolus 5-Fu 200 mg/(m2·d) and a 22-hour infusion of 5-Fu 400 mg/(m2·d) by center vein for 4 consecutive days. Treatment was repeated every 3 weeks. Thirty-seven cases in group B were treated with OXA, on d1, 5-Fu and CF, on d1~5, that the dose was same to group A, and the drugs were given by continuous center vein dripping. Twenty cases achieved a partial remission (PR), 8 cases remained stable disease(SD) and 8 cases progressive disease(PD). The response rate(RR) was 55.6% in group A with PR, 7 casee; SD, 15 cases; PD, 15 cases. The RR was 19.0% in group B after the sixth cycles of chemotherapy. There was significant difference between group A and group B(P<0.01). The overall tumor growth control rate (OTGCR, CR+PR+SD) was 77.8% in group A and 59.5% in group B, and there was no significant difference between group A and group B(P>0.05). The RR was 44.4% and 45.0% respectively in the patients with colorectal carcinoma with pelvic metastasis and liver metastasis; 33.3% in stomach cancer with liver metastasis, 25.0% in lung cancer, and 25.0% pancreatic cancer with liver metastasis, and no response in gallbladder carcinoma with liver metastasis. There was no significant difference between group A and group B in side effects except the peripheral sensory neuropathy was markedly less in group A than that of group B. [Conclusion] OXA plus 5-Fu and CF is effective in treating tumors resisting to DDP or CBP, and higher response rate and less peripheral sensory neuropathy are achieved by arterial injection than that by venous dripping.