奥沙利铂联合氟尿嘧啶/亚叶酸钙时辰化疗治疗晚期胃肠道肿瘤的临床观察

A clinical study of chronomodulated chemotherapy of oxaliplatin, 5-fluorouracil and folinic acid regimen in the advanced gastrointestinal cancer

目的：观察奥沙利铂联合氟尿嘧啶／亚叶酸钙（FFL方案）时辰输注法治疗晚期胃肠道肿瘤的近期疗效和毒性反应。方法：FFL方案时辰输注法治疗32例晚期胃肠道肿瘤患者，奥沙利铂25mg／（m^2·d）（10：00～22：00），氟尿嘧啶600mg/（m^2·d）（22：00～10：00），亚叶酸钙300mg/（m^2·d）（22：00～10：00），分别加5％葡萄糖液至200ml，通过四通道程控时辰输液泵连续给药5天，每21天为1个周期，至少用2个周期。根据世界卫生组织实体瘤化疗判定标准（1981）评价近期疗效。结果：32例患者中，完全缓解（CR）1例（3．1％），部分缓解（PR）14例（43．8％），稳定（SD）13例（40．6％），进展（PD）4例（12．5％），总有效率为46．9％。在共102个周期的化疗中，最常见的不良反应为血液学毒性、胃肠道毒性、外周神经毒性，但均以Ⅰ度为主，Ⅲ度迟发性腹泻发生2例次，未出现Ⅳ度不良反应。结论：FFL方案时辰输注法具有疗效高及毒副作用低等优点，可作为晚期胃肠道肿瘤的推荐化疗方案之一。

Objective： To investigate the efficacy and safety of combination of oxaliplatin （ L-OHP）, 5-fluorouracil （5-FU） and folinic acid （LV） in form of chronomodulated chemotherapy for advanced gastrointestinal cancer. Methods：Thirty-two patients received a 5-day chronomodulated infusion of L-OHP, 5-FU and LV. L-OHP（25 mg·m^-2·d^-1 ） infused from 10：00 am to 22：00 pm, and followed by 5-FU （600mg·m^-2·d^-1）and LV （300mg·m^-2·d^-1） from 22：00 pm to 10：00 am for 5 days using a muhichannel programmable pump, every 3 weeks as an cycle for at least 2 cycles according to WHO criteria. Results：One complete and 14 partial remissions were observed in all 32 patients with an overall response rate of 46. 9%. Stable disease was observed in 13 patients （40. 6% ） and progressive disease in 4 （ 12.5% ）. A total of 102 cycles were given without any grade 4 toxicity observed, The main toxicities were grade 1 bone marrow suppression, toxicitiy of alimentary canal and neurotoxicity, but grade 3 delayed diarrhea in two patients. Conclusion：Chronomodulated intravenous chemotherapy of oxaliplatin, 5-fluororuacil and folinic acid is effective and safe in the treatment of advanced gastrointestinal cancer.