大剂量氨甲喋呤四氢叶酸钙解救疗法的临床应用

The Clinical Application of HD-MTX and CF Rescue in Patients with Advanced Cancer

本文报告用HDMTX-CFR方法治疗13例晚期恶性肿瘤的结果。MTX单次用量3～6g。12例可评定疗效,部分缓解者4例,稳定6例,总有效率83.3％。毒性表现以消化道反应、骨髓抑制、皮肤损害常见。全组无毒副反应死亡者。作者指出在无血浆药物浓度监测条件下,认真选择病例、排除肾功不全及胸,腹水等,治疗中严格遵守“水化”“硷化”原则,保持尿量≥3000ml/日,pH≥7、则不会发生严重毒性反应。本组中有8例消化道癌均属有效,另有3例治疗后肿瘤缩小,再次切除成功,应予注意。

Thirteen patients with various advanced malignant tumors treated with high dose methotrexate followed by citrovorum factor rescue (HD-MTX-CFR) are reported. A total of 23 courses of HD-MTX-CFR were administrated. Dosage of MTX varied from 3.0 to 6.0 gm in one bolus. In 12 of 13 evaluabte patients, 4 showed tumor partial remission after treatment and 6 had stable disease. The overall response rate was approximately 83.3%. The conmon side effects encountered were digestive tract reaction, suppression of bone marrow and skin damage. No patients died of therapy related complication. The authors point out that careful selection of patients, excluding those who have renal function impairment or ascitic or pleural effusion and adherence to the required 'hydration' and 'alkalization' to keep the urine amount in excess of 3000 ml/day with pH≥7.0, can minimize the side-effects and avoid serious toxic reaction. All 8 cases of digestive tract carcinoma in this series were responded well and another 3 patients who showed partial remission underwent subsequently a successful resection of the tumor.