XELOX方案辅助化疗治疗老年结直肠癌的疗效评估

XELOX adjuvant chemotherapy efficacy in colorectal cancer assessment of the elderly

目的:观察希罗达联合奥沙利铂(XELOX)治疗老年性晚期结直肠癌的疗效及安全性。方法:将我院2005年4月～2009年10月间收治的164例老年晚期转移性结直肠癌患者随机分为两组,治疗组为XELOX组82例,予卡培他滨联合奥沙利铂方案化疗,卡培他滨1000 mg/m2,口服,2次/d,第1～14 d;奥沙利铂130 mg/m2,静脉点滴,第1 d;21 d1周期。对照组为FOLFOX4组82例,予5-氟尿嘧啶,亚叶酸钙联合奥沙利铂方案化疗,奥沙利铂85 mg/m2,静脉点滴,第1 d;亚叶酸钙200 mg/m2,静滴2 h后予5-氟尿嘧啶400 mg/m2,推注,后续600 mg/m2,持续静滴22 h,第1、2 d;每2 w重复,4 w为1周期。两组均治2周期以上。按WHO标准评价客观疗效和不良反应。结果:164例患者均完成化疗疗程。XELOX组总有效率49.2%,临床控制率为81.7%,其中完全缓解8例(9.8%),部分缓解32例(39.4%),病情稳定27例(32.9%),病情进展15例(18.3%)。中位进展时间为8.2个月。FOLFOX4组总有效率43.9%,临床控制率为78.0%,其中完全缓解7例(8.5%),部分缓解29例(35.4%),病情稳定28例(34.1%),病情进展18例(22.0%)。中位进展时间为7.9个月。两组近期有效率无明显统计学差异。不良反应比较,手足综合症以XELOX组显著(P<0.05),恶心呕吐发生率以FOLFOX4组高(P<0.05),XELOX方案中的中性粒细胞减少和神经毒性发生率分别为8.5%和2.4%,显著低于FOLFOX4方案的47.6%和46.3%(P<0.01)。结论:XELOX方案与FOLFOX4方案的疗效近似,但XELOX方案用药更为方便,安全性更好。值得推广应用。

Objective:Observation the efficacy and safety of XELOX to treat of senile advanced colorectal cancer.Methods:To our hospital from April 2005 to October 2009 among 164 cases admitted to elderly patients with advanced metastatic colorectal cancer patients were randomly divided into two groups,treatment group for the XELOX group of 82 cases,I Capecitabine and Oxaliplatin in the programchemotherapy,capecitabine 1000 mg/m2,orally 2 times / day,the first one to 14 days;oxaliplatin 130mg/m2,intravenous drip,day 1;21 days a cycle.The control group FOLFOX4 group of 82 cases,giving 5-Fluorouracil,Leucovorin and Oxaliplatin regimen with oxaliplatin 85 mg/m2,intravenous drip,day 1;leucovorin 200mg/ m2,intravenous infusion of 2 hours later,5-fluorouracil 400 mg/m2,bolus,follow-up 600mg/m2,continuous infusion 22 hours,the first 1,2 days;repeated every 2 weeks,4 weeks of a cycle.Rule for more than two cycles in both groups.According to WHO criteria to evaluate objectively the efficacy and adverse reactions.Results:164 patients had completed chemotherapy treatment.XELOX group,the total efficiency of 49.2%,the clinical control rate was 81.7%,including complete response in 8 cases(9.8%),partial remission in 32 cases(39.4%),stable disease in 27 cases(32.9%),disease progression in 15 cases(18.3%).The median time to progression was 8.2 months.FOLFOX4 group,the total efficiency of 43.9%,the clinical control rate was 78.0%,including complete remission in 7 cases(8.5%),partial remission in 29 cases(35.4%),in a stable condition in 28 cases (34.1%),disease progression in 18 cases(22.0%).The median time to progression was 7.9 months.Two sets of short-term effect no significant statistical difference.Adverse reactions compared to hand-foot syndrome with XELOX was significantly(P<0.05),the incidence of nausea and vomiting with a high FOLFOX4 group(P<0.05),XELOX programs neutropenia and neurological toxicity rates were 8.5% and2.4%,significantly lower than the 47.6% and FOLFOX4 program 46.3%(P<0.01).Conclusion:XELOX and FOLFOX4 program similar to the efficacy of the program,but the XELOX drug program is more convenient and better security.