S-1联合DDP腹腔恒温循环热灌注治疗胃癌合并腹水的临床疗效观察

Clinical observation of therapeutic effects of S-1 combined with DDP circulatory thermochemotherapy of intraperitoneal perfusion for advanced gastric carcinoma with ascites

目的观察替吉奥(S-1)联合顺铂(DDP)腹腔循环热灌注化疗治疗胃癌合并腹水的临床疗效及不良反应。方法 134例患者随机分为试验组(循环热灌注组,n=67)和对照组(普通热灌注组,n=67)。S-1均按体表面积给药,服药2周,停药1周,DDP腹腔给药,d1 90 mg,d8 60 mg。试验组经恒温循环热灌注仪给药,对照组加入预热的41～43℃0.9%生理盐水100 ml直接腹腔注入。21 d为1周期,2周期后参照WHO标准评价客观疗效及不良反应。结果实际可评价134例,试验组腹水有效控制率为67.16%(45/67),对照组为47.76%(32/67),差异有统计学意义(P<0.05)。临床受益反应率为82.1%(55/67),对照组临床受益率为67.2%(45/67),差异有统计学意义(P<0.05)。两组不良反应主要为白细胞减少、贫血、恶心、呕吐等,组间无统计学差异(P>0.05)。结论与传统治疗方法相比,S-1联合DDP恒温循环热灌注治疗胃癌合并恶性腹水能取的更好的疗效且不增加毒副反应,值得进一步研究应用。

Objective To observe therapeutic effects and adverse effects of S-1 combined with DDP by circulatory thermochemotherapy of intraperitoneal perfusion for advanced gastric carcinoma with ascites. Methods 134 patients of advanced gastric carcinoma with malignant ascites were randomly divided into trial group（circulatory thermochemotherapy group, n=67） and control group（common thermochemotherapy group, n=67）. All of patients in both groups were given with S-1 orally according to body surface area, twice daily for 2 weeks, drug withdrawl for 1 week. In trial group, 90 mg DDP was given on the first day and 60 mg DDP on the eighth day respectively by circulatory thermochemotherapy instrument. In control group, the same dosage of DDP was dissolved in 100 ml preheated 0.9% physiological saline（41-43℃） and injected into peritoneal cavity directly. Twenty one days makes a cycle, 2 cycles totally in both groups. The efficacy and adverse effects were evaluated according to the common toxicity criteria of WHO. Results 134 cases of patients could be given an objective evaluation of the efficacy and side effects. The response rate was 67.16%（45/67） in trial group and 47.76%（32/67） in control group （P〈0.05）. The clinical benefit response rate was 82.1%（55/67） in trial group and 67.2%（45/67） in control group（P〈0.05）. The adverse effects were no statistically significant difference between both groups（P〉0.05）, mainly as leucopenia, anemia, nausea, and vomiting. Conclusion Comparing with the traditional treatment methods, cycle thermochemotherapy of intraperitoneal perfusion for advanced gastric carcinoma with malignant ascites can take better efficacy without increasing toxicity. It is worthy of studying further in clinic.