洛铂联合紫杉醇治疗中晚期食管癌的不良反应

The adverse effects of chemotherapy with lobaplatin and paclitaxel in middle and advanced stage esophageal carcinoma

背景与目的:化疗是中晚期食管癌治疗手段之一,选择低毒有效的化疗方案是关键,本研究旨在观察洛铂联合紫杉醇治疗食管癌的不良反应。方法:2010年4月15日至2011年5月之间,共收治中晚期食管鳞癌患者129例,其中初治患者35例,根治术后患者94例,化疗方案:紫杉醇135 mg/m2,第1天;洛铂35 mg/m2,第2天,重复3周。共化疗289个周期,平均每例2.2个周期。结果:在35例初治患者中,完全缓解(CR)7例(20.0%)、部分缓解(PR)21例(60.0%)、无变化(SD)7例(20.0%),总有效率RR(CR+PR)为80.0%;术后辅助治疗有10例(10.6%)出现复发或转移。与化疗有关的不良反应主要表现为:①骨髓抑制,其中白细胞下降Ⅰ、Ⅱ度59例(45.7%),Ⅲ、Ⅳ度16例(12.4%),血小板下降Ⅰ、Ⅱ度27例(20.9%),Ⅲ、Ⅳ度2例(1.6%),血红蛋白下降Ⅰ、Ⅱ度62例(48.1%),Ⅲ、Ⅳ度7例(5.4%);②脱发112例(86.8%);③肌肉或关节痛69例(53.5%);④肝功能损伤Ⅰ、Ⅱ度15例(11.6%);⑤胃肠道反应Ⅰ、Ⅱ度16例(12.4%);⑥无明显肾功能异常及过敏反应。结论:洛铂联合紫杉醇治疗食管癌的不良反应轻,患者能够耐受,近期疗效好,值得临床进一步研究。

Background and purpose： Chemotherapy is one of the treatment methods of advanced esophageal carcinoma. It is vital to select an effective and low toxicity chemotherapy regimen. The purpose of this study was to investigate the adverse effects of chemotherapy with lobaplatin and paclitaxel in the treatment of middle and advanced stage esophageal carcinoma. Methods： From Apr. 2010 to May 2011, 129 patients with middle and advanced stage esophageal carcinoma （35 initial treatment patients and 94 postoperative patients） underwent chemotherapy. The chemotherapy consisted of paelitaxel （135 mg/m2） on day 1 and lobaplatin （35 mg/m2） on day 2, 21 days per cycle. There were 289 cycles in all and mean 2.2 cycles per patient. Results： Among 35 initial treatment patients, complete release （CR） occurred in 7 patients （20.0%）, partial release （PR） in 21 patients （60.0%） and stable disease （SD） in 7 patients （20.0%）. The total effective rate was 80% （CR＋PR）. Among postoperative patients, 10 patients had metastases or recurrences （10.6%）. The adverse effects mainly represented as following： ①Myelotoxicity principally showed leucopenia at grade I - II occurred in 59 patients （45.7%） and at grade III-IV in 16 patients （12.4%）, thrombopenia at grade I - II occurred in 27 patients （20.9%） and at grade III-IV in 26 patients （1.6%）, hypohemoglobinemia at grade I -II occurred in 62 patients （48.1%） and at grade III-IV in 7 patients （5.4%）; ②Baldness occurred in 112 patients （86.8%）; ③Pain of muscles or arthralgia occurred in 69 patients （53.5%）; ④Liver function abnormal at grade I - II occurred in 15 patients （11.6%）; ⑤Responses of gastrointestinal tract at grade I -II occurred in 16 patients （12.4%）; ⑥There was no obvious renal function abnormal and allergy. Conclusion： The adverse effects of chemotherapy with lobaplatin and paelitaxel in advanced esophageal carcinoma were slight and tolerable. The recent treatment result was good and worth further study.