奥沙利铂联合甲酰四氢叶酸钙和氟尿嘧啶新辅助化疗方案治疗进展期胃癌的研究

Oxaliplatin in combination with calcium folinate and fluorouracil as neoadjuvant chemotherapy in the treatment of advanced gastric cancer

目的评价奥沙利铂(OXA)联合甲酰四氢叶酸钙(LV)和氟尿嘧啶(5-FU)新辅助化疗方案(OXA-LV5FU2)治疗进展期胃癌的疗效与毒副作用。方法27例进展期胃癌患者接受OXA-LVSFU2治疗：OXA 100 mg/m^2,静脉滴注2 h,第1天；LV 200 mg/m^2,静脉滴注2 h后推注5-FU 400 mg/m^2,后续5-FU 1g/m^2以麻醉镇痛泵持续48-72 h恒速静脉输入,第1、2天。每2-3周为1个疗程,共3～4个疗程。观察新辅助化疗后肿瘤原发病灶的缓解情况及其不良反应。结果新辅助化疗后27例患者中24例获得手术切除,其中14例获得根治性切除。临床有效率为48．1%,其中3．7% (1例)完全缓解,44．4%(12例)部分缓解,33．3%(9例)病情稳定,18．5%(5例)病情进展。8例肿瘤TNM分期降低。不良反应主要为恶心呕吐、外周感觉神经异常、白细胞减少症、脱发、肝功能异常,对症治疗可缓解。无化疗相关死亡者。结论OXA-LV5FU2新辅助化疗方案在进展期胃癌的治疗中近期疗效显著,耐受性良好。

Objective To evaluate the efficacy and toxicity of oxaliplatin in combination with calcium folinate and fluorouracil （OXA-LV5FU2）regimen as the neoadjuvant chemotherapy in the treatment of patients with advanced gastric cancer. Methods Twenty-seven patients were treated with OXA-LV5FU2 before operation. Neoadjvant chemotherapy regimens containing OXA 100 mg/m^2 iv 2 h d1, LV 200 mg/m^2 iv 2 h followed by 5-FU 400 mg/m^2 iv bolus and 5-FU 1 g/m^2 iv 48-72 h dl, 2 were administered every 2 to 3 weeks for 3 to 4 cycles before local treatment. The responses of the primary tumor and the chemotherapy toxicity were observed in each patient. Results Twenty-four patients were treated with surgery. The radical resections were carried out in 14 cases. The overall clinical efficacy rate was 48.1% with 3.7% CR and 44.4% PR, SD was 33.3% and PD was 18.5%. Eight of the 27 cases were downstaged. The common toxicities were nausea, vomiting, peripheral neuropathy, leukocytopenia, alopecia and hepatosis. The toxicities relieved after symptomatic treatment. There was no relative risk of death during treatment. Conclusion OXA-LV5FU2 is a very effective and well tolerated regimen as neoadjvant chemotherapy for advanced gastric cancer.