含羟基喜树碱的序贯化疗方案治疗中、晚期胃癌的初步探讨

Sequential chemotherapy with hydroxycamptothecine, 5-Fu and cisplatin for treatment of advanced gastric adenocarcinoma

目的 观察甲酰四氢叶酸钙 (LV)、较小剂量氟尿嘧啶 (5 Fu)与顺铂 (DDP)加羟基喜树碱(HCPT)组成的FDH方案序贯给药 ,治疗中、晚期胃癌的临床疗效。方法 治疗组 2 3例 ,给予FDH方案 ;对照组 30例 ,用 5 Fu、阿霉素 (Ara c)和丝裂霉素组成的FAM方案。两个方案均以时间先后顺序给药。FDH方案为LV 10 0mg/d ,静脉注射 ,30min内滴完 ;5 Fu 5 0 0mg/m2 静脉滴注 ,持续 8h ,第 1～ 5天 ;顺铂 10mg/m2 静脉注射 ,第 1～ 5天 ;HCPT 10mg/m2 静脉滴注 1h ,第 1～ 5天 ;每月为 1个疗程。FAM方案为LV 10 0mg/d ,静脉注射 ,30min内滴完 ;5 Fu 75 0～ 10 0 0mg/m2 静脉滴注第 1～ 5天 ;阿霉素 30mg/m2 静脉注射 ,第 1天 ;丝裂霉素 6mg/m2 静脉注射 ,第 1天 ,每月为 1个疗程。每例至少用完 2个疗程 ,方可评价疗效。结果 FDH组 2 3例中 ,完全缓解 (CR) 1例 ,部分缓解 (PR) 12例 ,稳定 (NC) 6例 ,进展 (PD) 4例 ,有效率为 5 6 .3%。FAM组 30例 ,PR 9例 ,NC 13例 ,PD 8例 ,有效率为 33.3 % ,两组有效率比较 ,差异有显著性 (P <0 .0 5 )。两组主要不良反应均为白细胞减少和胃肠道反应 ,FDH组Ⅲ～Ⅳ度的白细胞下降 (2 1.7% )较FAM组 (4 6 .4% )低 (P <0 .0 5 ) ,未见心、肾、膀胱炎等不良反应。结论 FDH方案治疗中、?

Objective To evaluate the efficacy and adverse reactions of low dose FDH (calcium leucovorin, LV; 5 Fu; cisplatin and hydroxycamptothecine) in the treatment of advanced gastric adenocarcinomas. Methods Fifty three patients with advanced gastric adenocarcinomas were enrolled in the clinical study, 23 cases were treated with FDH regimen as study group and 30 cases were treated with FAM regimen as control group. In the study group, all the antineoplastic drugs were given by the time sequence of: LV(100 mg/d, i.v in 30 minutes), 5 Fu (500 mg/m 2, i.v in 8 hours, 1～5 days), cisplatin (10 mg/m 2, i.v, 1～5 days), HCPT (10 mg/m 2, i.v in 1 hour, 1～5 dyas). In the control group, patients were given LV (100 mg/d, i.v in 30 minutes), 5 Fu (750～1 000 mg/m 2, i.v in 24 hours, 1～5 days), Ara c(30 mg/m 2, i.v, on 1st day), mitomycin (6 mg/m 2, i.v, on 1st day). One month was taken as a course of treatment. For evaluation of the results, at least two courses should be completed. Results In both groups, all patients completed the therapy, with completion rate of 100%. In FDH group, 13 patients were evaluated as responsive cases, 1 was CR and 12 were PR with a response rate (RR) of 56.3%. In FAM group, 9 cases were considered as PR with a RR of 33.3%. The main adverse reactions of the chemotherapy were leukopenia and gastrointestinal discomfort such as nausea and vomiting. Cardio toxicity and nephro toxicity have not been observed. The incidence of leukopenia in FDH group was much lower (21.7%) than that in the FAM group(46.4%)( P < 0.05). Conclusion Combination chemotherapy of 5 Fu, cisplatin and HCPT achieved a better response rate than FAM regimen in treatment of advanced gastric adenocarcinoma and with fewer adverse reaction. More clinical study by the above mentioned chemotherapeutic modality is needed.