介入、热疗联合FOLFOX辅助治疗术后Ⅲ期结肠癌患者的疗效分析

Interventional or hyperthermia therapy combined with FOLFOX regimen used in the postoperative adjuvant treatment of stage Ⅲ colorectal cancer patients

背景与目的:奥沙利铂(oxaliplatin,L-OHP)联合氟尿嘧啶(5-fluorouracil,5-FU)、亚叶酸钙(calcium folinatc,CF)方案为Ⅲ期结肠癌患者标准治疗方案,但L-OHP联合方案带来较多的不良反应,为此寻找不同的方法以减少药物毒性是治疗的关键。本文评价Ⅲ期结肠癌患者术后辅助介入、热疗联合化疗的临床疗效及不良反应。方法:回顾性分析2003年—2005年本科室治疗的123例Ⅲ期结肠癌术后患者的临床资料。根据不同的疗法,将患者随机分为3组。FOLFOX单纯化疗组(A组)57例,给予L-OHP 130 mg/m2静脉滴注,持续3.5 h,第1天;CF 200 mg/m2静脉滴注,持续2 h,第1～5天;5-FU 300 mg/m2静脉滴注,持续6 h,第1～5天;FOLFOX+介入治疗组(B组)35例,给予L-OHP、5-FU和CF,并以介入方式灌注肠系膜动脉,第1天,其余同A组;FOLFOX+热疗组(C组)31例,在A组基础上,于L-OHP静脉滴注时热疗。3种方案均为每3周重复1次,共8个周期。观察患者的3年无病存活率(disease-free survival,DFS)和5年存活率(overall survival,OS)及药物的不良反应等。结果:3组患者的DFS分别为71.9%、77.1%和77.4%,差异无统计学意义(P=0.793)。3组患者的OS分别为56.1%、57.1%和58.1%,差异无统计学意义(P=0.984)。B、C组患者的中性粒细胞减少及外周神经系统不良反应低于A组,差异有统计学意义(P<0.001)。结论:Ⅲ期结肠癌患者术后辅助治疗选择介入、热疗联合化疗安全、有效,临床疗效与文献报道相仿。

Background and purpose： Oxaliplatin （L-OHP） combined with fluorouracil （5-FU） and calcium folinatc （CF） as the standard adjuvant chemotherapy for the patients with stage Ⅲ colorectal cancer. But it leads to many adverse effects. So we look for different methods to get low rates of it. The purpose of this study was to evaluate the effect and toxicity of interventional or hyperthermia therapy combined with FOLFOX regimen used in the postoperative adjuvant treatment of stage Ⅲ colorectal cancer. Methods： We retrospective analyzed 123 patients with stage Ⅲ colorectal cancer, all patients were. randomized into 3 groups,57 cases in FOLFOX chemotherapy group （group A）, 35 cases in chemotherapy plus interventional therapy （group B）and 31 cases in chemotherapy plus hyperthermia therapy （group C）.Group A patients were treated with L-OHP plus 5-FU/CF. L-OHP 130 mg/m2 was administered, iv infusion 3.5 h, d 1; CF 200 mg/m2, iv infusion for 2 h, d 1-5; followed by 5-FU 300 mg/m2, iv infusion over a period of 6 h, d 1-5. Group B patients were treated with continuous mesenteric arterial infusion L-OHP plus 5-FU/CF, d 1 ; the same FL regimen was used in group B. Patients of group C were treated with L-OHP 130 mg/m2 was administered, iv infusion 3.5 h, d 1, received hyperthermia therapy for 1 h at the same time. These treatments were repeated every 3 weeks to a total of 8 cycles. Results： Among 123 patients, the 3 years disease-free survival rates of group A, B and C were 71.9%, 77.1% and 77.4% respectively （P=0.793, no statistically significant）. The 5 years overall survival rates of group A, B and C were 56.1%, 57.1% and 58.1% respectively （P=0.984, no statistically significant）. Among the side effects, the neutropenia and peripheral neurologic adverse event of group B and C were less than that of group A and which was significant. Conclusion： Choosing interventional or hyperthermia therapy combined with FOLFOX as an postoperative adjuvant treatment for stage Ⅲ colorectal cancer is safe, effective, and proved to have the similar curative effects as literature reported.