DOF与DCF方案治疗进展期胃癌的临床对照观察

目的:本研究旨在评价多西他赛联合奥沙利铂、氟脲嘧啶(DOF方案)与多西他赛联合顺铂、氟脲嘧啶(DCF方案)组成的5天联合方案一线治疗进展期胃癌的有效性和安全性。方法:75例患者分为A、B两组。A组38例,接受DOF方案:多西他赛75mg/m2第2天,奥沙利铂130mg/m2第1天,氟脲嘧啶500mg/m2第1～5天;B组37例,接受DCF方案:多西他赛75mg/m2第2天,顺铂25mg/m2第1～3天,氟脲嘧啶500mg/m2第1～5天。均每3周重复,至少应用2周期。结果:A组患者临床控制率、完全缓解率、部分缓解、中位治疗至进展时间、中位生存期以及1年生存率和2年的生存率分别为65.78%、5.26%、42.10%、5.9月、11.2月、52.63%、18.42%。B组分别为54.06%、2.70%、35.14%、5.8月、10.8月、48.64%、13.51%。治疗前两组生活质量(QOL)分值相当,但是治疗后1月、2月的QOL分值有差异(P<0.05)。两组生存期比较无显著差异(P>0.05)。两组主要毒副反应为骨髓抑制、恶心呕吐,但不严重。结论:多西他赛联合奥沙利铂、氟脲嘧啶和多西他赛联合顺铂、氟脲嘧啶一线治疗进展期胃癌疗效均确切、毒副反应均可以接受。与最好的支持治疗相比联合化疗可延长患者生存期,提高生活质量。特别是前者对生活质量的影响比后者轻。

Objective:To compare and evaluate the eff icacy and safety of 'docetaxel+oxaliplatin+fluorouracil' or 'docetaxel+cisplatin+fluorouracil' 5-day combination chemotherapy as treatment in patients with advanced gastric cancer. Methods: 75 patients with advanced gastric cancer were randomly divided into two groups(A and B). Patients in group A(38 cases)were treated with docetaxel 75mg/m2 on day 2,oxaliplatin 130mg/m2 on day 1,? uorouracil 500mg/m2 on days 1～5,and patients in group B(37 cases) were treated with docetaxel 75mg/m2 on day 2,cisplatin 25mg/m2 on days 1～3,fluorouracil 500mg/m2 on days 1～5.Both regimens were repeated every 3 weeks for at least 2 cycles. Results:The clinlcal response rate,completed response rate,partial response rate,median time to progression,median survival time,1- year and 2-year survival rate were 65.78%,5.26%,42.10%,5.9months,11.2 months 52.63% and 18.42% in group A respectively,and 54.06%,2.70%,35.14%,5.8months,10.8 months,48.64% and 13.51% in group B. There were differences in the QOL scores between after the treatment between the two groups(P<0.05).There were no sighifi cant differences in survival time between the two groups(P>0.05).Themain toxicities of the two groups were bone marrow depression,nausea and vomiting .All the toxicities were mild and tolerable.Conclusion: The combination chemotherapy of 'docetaxel+oxaliplatin+fluorouracil' and 'docetaxel+cisplatin+fluorouracil' are active and tolerable regimen for treatment of patients with advanced gastric cancer. Compared with optimal supportive care alone,combination chemotherapy yields a signif icant advantage in the management of advanced gastric cancer.