草酸铂及亚叶酸钙分别联合替加氟或氟尿嘧啶治疗晚期胃癌疗效比较

Efficacy comparison of tegafur or fluorouracil combined with oxaliplatin and calcium folinate to treat patients with advanced gastric cancer

目的比较草酸铂联合亚叶酸钙、替加氟方案与草酸铂联合亚叶酸钙、氟尿嘧啶方案治疗晚期胃癌的临床疗效和毒性。方法选择已确诊的晚期胃癌共68例,随机分为A、B两组。A组(33例)草酸铂(OXA)140mg/m2,静滴2h,d1;亚叶酸钙(CF)150mg/m2,静滴后续替加氟1.0静滴,d1～10,为1周期,3周后重复。B组(35例):草酸铂及亚叶酸钙剂量及用法同A组,氟尿嘧啶400mg/m2接亚叶酸钙后静脉持续输注24h,d1～5,为一周期,3周后复查。经4周期治疗后判定疗效。结果A组中CR1例(3.0%),PR18例(54.5%),RR19例(57.6%);B组中CR0例,PR18例(51.4%),RR51.4%。A组疗效较B组好,但两组结果比较差异无显著性意义(P﹥0.05)。A组不良反应3或4度者6例(18.2%),均为白细胞减少。B组不良反应3或4度者13例,其中白细胞减少7例(20.0%),口腔炎2例(5.8%),呕吐2例(5.8%),腹泻、便秘2例(5.8%),两组比较有显著性差异(P﹤0.05)。结论替加氟代替氟尿嘧啶联合草酸铂及亚叶酸钙是治疗晚期胃癌的有效方案,毒副反应轻,安全,且给药简便、易行。

Objective To compare the efficacy and toxicity of oxaliplatin （OXA） and calcium folinate （CF） combined with tegafur or fluorouracil （5-FU） to treat patients with advanced gastric caner. Methods Randomized 68 patients with advanced gastric caner into group A of 33 and group B of 35. Regimen of group A was： OXA 140mg/m^2 iv.drip 2hrs., d1; CF 150 mg/m^2 iv.drip followed by tegafur 1000mg, d1-10; repeated every 3 weeks. That of group B： OXA 140mg/m^2 iv.drip 2hrs., d1; CF 150 mg/m^2 iv.drip followed by 5-FU 400mg/m^2 c.i.v.24hrs., d1-5; also repeated every 3 weeks. Efficacy and toxicity were evaluated after 4 cycles. Results In group A, 1 patients achieved CR（3.0%）, 18 PR（54.5%）, with a RR of 57.6%. In group B, 0 CR and 18PR（51.4%）, RR was 51.4%. It seemed efficacy in group A was better, but not significant（P〉0.05）. Grade 3 or 4 toxicities were found in 6 patients out from group A. All were neutropenia （18.2%）. While 13 in group B, containing 7 with neutropenia （20.0%）, 2 with stomatitis（5.6%）, 2 with vomiting（5.6%）, 2 with diarrhea or oppilation（5.6%）. The toxicities were significantly different between the two groups （P〈0.05）. Conclusion Tegafur instead of 5-FU combined with OXA/CF to treat patients with advanced gastric caner was simple, available, effective and with more little toxicity.