动静脉结合给药的FLEEOX方案对以淋巴结转移为主晚期胃癌的新辅助化疗

Neoadjuvant chemotherapy of FLEEOX regimen for unresectable gastric cancer resulting from advanced abdominal lymph nodes metastases

目的观察动静脉结合给药的FLEEOX方案新辅助化疗对以淋巴结严重转移为主的晚期胃癌的疗效。方法2007年1月至2008年10月选择32例以淋巴结严重转移的晚期胃癌患者，其中术前cT判断伴严重的局部淋巴结转移者28例，如严重的第3、7、9、12等组淋巴结转移相互融合，包绕相应的重要血管、脏器；伴第16组淋巴结转移1例；同时伴局部与第16组淋巴结转移者3例。采取动静脉结合给药的方法进行新辅助化疗，方案为氟尿嘧啶（5-Fu）370mg／m^2，缓慢静脉滴注，第1—5天；亚叶酸钙120mg，静脉滴注，第1—5天；奥沙利铂150mg／m^2、表阿霉素30mg／m^2、依托苷泊70mg／m^2，动脉介入注射到癌肿所在部位，第6、20天。整个疗程每5周重复1次。化疗1～2个疗程以后，根据症状的缓解情况复查CT，计算肿瘤缩小率。结果治疗1～2个疗程后所有病例的症状都明显改善，cT评价完全缓解4例，部分缓解24例，肿瘤无变化4例，CT评价有效率为87．5％（28／32）。除2例肿瘤无变化者外，其他均在化疗结束后的第5～21天进行了胃次全、全胃或联合脏器切除手术，淋巴结清扫采取D2、D2＋α（转移淋巴结切除）。结论动静脉结合给药的FLEEOX新辅助化疗对于以淋巴结转移为主的晚期胃癌具有较好的疗效，动静脉不同的给药途径是提高胃癌新辅助化疗疗效的一种办法。

Objective To observe the therapeutic response of advanced gastric cancer with severe lymph nodes metastasis to FLEEOX regimen neoadjuvant chemotherapy that combined arterial and venous administration. Methods Neoadjuvant chemotherapy was administered to 32 cases of gastric cancer with advanced abdominal lymph nodes metastases from January 2007 to Octorber 2008. Of the 32 patients, 28 had severe local lymph nodes metastasis, such as No. 3, 7,9,12 lymph nodes metastasis, one patient had No. 16 lymph nodes metastasis, and the other 3 patients had both regional and No. 16 lymph nodes metastasis under CT scan. Neoadjuvant chemotherapy was administered as follows： 5-Fu 370 mg/m^2 , intravenous drip, day 1-5; Leukovorin 120 mg, intravenous drip, day 1-5; oxaliplatin 150 mg/m^2, epirubicin 30 mg/m^2 and epotoside 70 mg/m^2, intravascular infusion through arteria gastrica sinistra, day 6 and 20. The protocol was repeated every five weeks for two or three courses. After 2 or 3 cycles of chemotherapy, abdominal CT was taken to evaluate the radiological therapeutic response and calculate the reductive rate of the tumor. Results The general conditions and symptoms was improved significantly in all the patients. Four cases got complete response（CR） , 24 got partial response（PR） and 4 got no change under CT scan. For the 32 case, the radiological response rate （ CR ＋ PR ） was 87. 5% （ 28/32 ）. Thirty patients underwent subtotal or total gastrectomy, even combined organ resection, with D2 or D2 ＋ α lymphadenectomy. Conclusions The FLEEOX regimen which combines arterial and venous administration carries a satisfactory therapeutic effect in advanced gastric cancer with severe lymph nodes metastasis. The combined routes of drug administration may improve the effects of neoadjuvant chemotherapy in stomach cancer.