改良DCF方案与FOLFOX 4方案治疗晚期胃癌的临床疗效

Clinical observation of modified DCF regimen versus FOLFOX 4 regimen as first-line treatment for advanced gastric cancer

目的：探讨改良DCF方案与FOLFOX 4方案一线治疗晚期胃癌的疗效和安全性。方法收集本院2010年1月至2013年7月收治的晚期胃癌患者47例，根据化疗方案分为改良DCF组（多西他赛60mg／m2静滴，d1；奥沙利铂100mg／m2静滴，d1；氟尿嘧啶400mg／m2静滴，d1～d2；氟尿嘧啶600mg／m248h持续泵入d2～d3；3周为1周期；n＝24）和FOLFOX 4组（奥沙利铂85mg／m2静滴，d1；亚叶酸钙200mg／m2静滴，d1～d2；氟尿嘧啶400mg／m2静滴，d1～d2；氟尿嘧啶600 mg／m2持续静滴22h；2周为1周期；n＝23）。每6周评价疗效。比较两组的有效率（ RR）、疾病控制率（ DCR）、无进展生存期（ PFS）和总生存期（ OS）。结果47例患者均可评价疗效。改良 DCF 组获 PR 6例、SD 16例、PD 2例， RR 为25.0％， DCR 为91.6％；FOLFOX 4组获PR 2例、SD 16例、PD 5例，RR为8.6％，DCR为78.2％。两组RR和DCR的差异无统计学意义（ P＞0.05）。改良DCF组的中位PFS为8.2个月，中位OS为11.5个月；FOLFOX 4组的中位PFS为5.8个月，中位OS为10.1个月，两组差异无统计学意义（ P＞0.05）。两组主要不良反应为骨髓抑制和消化道反应，均以1～2级为主，两组差异无统计学意义（ P＞0.05）。结论改良DCF方案与FOLFOX 4方案一线治疗晚期胃癌的疗效和不良反应相当，值得临床进一步探索。

Objective To evaluate the efficacy and toxicity of modified DCF regimen compared with FOLFOX 4 regimen as the first-line treatment for patients with advanced gastric cancer. Methods Form January 2010 to July 2013, 47 advanced gastric car-cinoma patients were enrolled in this study. Twenty-four patients received modified DCF regimen（ docetaxel 60mg/m2 iv,d1;oxaliplatin 100mg/m2 iv, d1;fluorouracil 400 mg/m2 iv, d1-d2;fluorouracil 600 mg/m2 civ 48h, d2-d3;21 days was a cycle） and 23 patients re-ceived FOLFOX 4 regimen（ oxaliplatin 85mg/m2 iv,d1; calcium folinate 200mg/m2 iv, d1-d2; fluorouracil 400mg/m2 iv, d1-d2; flu-orouracil 600 mg/m2 civ 22h;14 days was a cycle） . The efficacy was evaluated every 6 weeks. The response rate（ RR） , disease con-trol rate（DCR）, progression-free survival（PFS）and overall survival（OS）were analyzed between the two groups. Results Efficacy could be evaluated in all patients. Patients in modified DCF group achieved PR in 6 cases, SD in 16 cases and PD in 2 cases with RR of 25.0% and DCR of 91.6%. Patients in FOLFOX 4 group achieved PR in 2 cases, SD in 16 cases and PD in 5 cases with RR of 8.6% and DCR of 78.2%. The differences of DCR and RR between the two groups had no significance（ P〉0.05） . Meanwhile, the me-dian PFS and OS were 8.2 and 11.5 months in modified DCF group and 5.8 and 10.1 months in FOLFOX 4 group with no significant differences（ P〉0.05） . The main toxicities were myelosuppression and digestive tract reaction, mainly in grade 1-2, and the incidence of the two groups had no differences（ P〉0.05） . Conclusion There are similar efficacy and toxicities between modified DCF regimen and FOLFOX 4 regimen, which is worth further study.