CS方案和SOX方案治疗晚期胃癌的临床观察

The clinical research of CS regimen and SOX regimen in the treatment of advanced gastric carcinoma

目的比较替吉奥联合顺铂的CS方案与替吉奥联合奥沙利铂的SOX方案治疗晚期胃癌的近期疗效和毒副反应。方法经病理学诊断为晚期胃癌患者45例,随机分为CS组和SOX组。CS组:替吉奥胶囊(用量依体表面积而定:体表面积<1.25 m^2的患者,每次40 mg;体表面积≥1.25 m^2但<1.50 m^2者,每次50 mg;体表面积≥1.5 m^2者,每次60 mg)一天2次,第1～14天早、晚饭后分别口服;顺铂注射液75mg/m^2分三天(第1～3天)静脉滴注。每21天重复1次,至少治疗2个周期。SOX组:替吉奥胶囊(用量依体表面积而定:体表面积<1.25 m^2的患者,每次40 mg;体表面积≥1.25 m^2但<1.50 m^2者,每次50 mg;体表面积≥1.5 m^2者,每次60 mg)一天2次,第1～14天早、晚饭后分别口服;奥沙利铂注射液130 mg/m^2加入5%葡萄糖注射液250 ml避光缓慢静脉滴注2 h,第1天,每21天重复1次,至少治疗2个周期。全部病例均有可测量病灶进行客观疗效评价。结果 CS组:完全缓解(CR)0例,部分缓解(PR)4例,稳定(SD)11例,进展(PD)5例,有效率(RR)为20%,疾病控制率(DCR)为75%。SOX组:CR 0例,PR 9例,SD 13例,PD 3例,RR为36%,DCR为88%。两组RR和DCR差异无统计学意义。两组主要毒副反应为胃肠道反应、外周神经毒性、血液毒性和色素沉着,SOX组患者周围神经炎发生率明显高于CS组,χ~2=8.82,P=0.003,差异具有统计学意义。结论 CS方案和SOX方案治疗晚期胃癌近期疗效接近,SOX方案组周围神经炎发生率高但患者可以耐受,值得临床进一步研究应用。

Objective To observe the effects and adverse reactions of S-1/cisplatin regimen （CS） and S-1/Oxalipla- tin regimen （SOX） in the treatment of advanced gastric carcinoma. Methods 45 patients were randomized into CS group （20 patients received S-1 and cisplatin） and SOX group （25 patients received S-1 and oxaliplatin）. The clinical effects and adverse reactions were evaluated after two treatment cycles. Results The response rates were 20% （CR 0 cases, PR 4 cases） vs 36% （ CR 0 cases, PR 9 cases） （P 〉 0. 05 ） , and the disease control rates （DCR） were 75% vs 88% in CS group and SOX group, respectively （ P 〉 0. 05 ）. The main adverse reactions were gastrointestinal tract reaction, peripher- al sensory neuropathy, myelosuppression, and pigmentation. served in SOX group compared with CS group （P =0. 003）. A higher incidence of peripheral sensory neuropathy was ob- Conclusion Patients with advanced gastric carcinoma have a similar response rate （RR） to both CS regimen and SOX regimen, and the latter is of a higher incidence of peripheral sensory neuropathy which is tolerable and worth further investigation.