紫杉醇腹腔灌注化疗治疗胃癌恶性腹腔积液的临床研究

Intraabdominal infusion of Paclitaxel in treating malignant ascites of gastric cancer

目的观察紫杉醇(PTX)腹腔灌注化疗联合亚叶酸钙(LV)/5-氟尿嘧啶(5-Fu)/奥沙利铂(OXA)治疗胃癌恶性腹腔积液的疗效及安全性。方法 23例晚期胃癌合并癌性腹水患者接受PTX 60mg/m2腹腔灌注,第1,5,8d;LV 200mg/m2静脉滴注2h,第1-4d;5-Fu 750mg/m2持续静滴24h,每天1次,第1-4d;OXA 130mg/m2静滴2h,第1d。每21d为1个周期,每2个周期评价疗效。结果所有患者均可评价;有效率(RR)为69.6%,疾病控制率(DCR)为86.9%,中位肿瘤进展时间(TTP)为6.6个月,1年生存率为71%。主要不良反应有骨髓抑制、恶心呕吐、腹痛、腹泻、肌肉关节痛、口腔黏膜炎等,未见过敏反应及明显的肝肾功能损害,无治疗相关性死亡。结论紫杉醇腹腔灌注化疗治疗胃癌恶性腹腔积液疗效较好,且不良反应较轻,可以耐受,值得临床进一步推广应用。

Objective To observe the efficacy and safety of Paclitaxel （PTX） peritoneal perfusion chemotherapy combined with leucovorin（LV）/5-fluorouracil（5-Fu）/Oxaliplatin （OXA） in treating malignant ascites of gastric cancer. Methods Twenty-three cas-es of advanced gastric cancer with malignant ascites were treated with PTX 60mg/m2 via intraperitoneal on day 1,5,8;LV 200mg/m2 intravenous infusion for 2 hours on day 1 to 4;5-Fu 750mg/m2 intravenous infusion for 24 hours everyday on day 1 to 4;OXA 130mg/m2 intravenous infusion for 2 hours on day 1. The treatments were repeated every three weeks,the therapeutic effects were evaluated once every two weeks. Results All patients could be evaluated;The response rate （RR） was 69.6%,the disease control rate （DCR） was 86.9%,the median time to progression （TTP） was 6.6 months,one year survival rate was 71%. Major adverse reac-tions included bone marrow restraint,nausea and vomiting,abdominal pain,diarrhea,joint and muscle pain,oral inflammation;no allergic reaction and the obvious function of liver and kidney damage,there was no therapy-related death in all patients. Conclu-sion Intraabdominal infusion of Paclitaxel was effective in treating malignant ascites of gastric cancer,and the toxicity was rela-tively mild and tolerable;These results indicate that further clinical study is worthy.