目的:探讨体部立体定向放疗(stereotactic Body Radiation Therapy,SBRT)联合FOLFIRI方案转化治疗对结肠癌肝脏寡转移的疗效及安全性。方法:收集我院肿瘤科及结直肠外科2014年6月-2018年6月收治的有完整资料的结肠癌肝脏寡转移患者45例...目的:探讨体部立体定向放疗(stereotactic Body Radiation Therapy,SBRT)联合FOLFIRI方案转化治疗对结肠癌肝脏寡转移的疗效及安全性。方法:收集我院肿瘤科及结直肠外科2014年6月-2018年6月收治的有完整资料的结肠癌肝脏寡转移患者45例,其中SBRT联合FOLFIRI转化组(观察组)21例,术前行肝转移灶SBRT及FOLFIRI方案化疗6~8周期,化疗后4~6周行左/右半结肠切除术;FOLFOXIRI转化治疗组(对照组)24例,术前行FOLFOXIRI方案化疗6~8周期,化疗后4~6周行肝转移灶切除+左/右半结肠切除术。术后两组均行补充化疗4~6周期。比较观察组SBRT前后肝脏转移灶增强MRI表现,两组的客观缓解率(ORR)、中位无进展生存期(PFS)、中位总生存期(OS)、不良反应及两组的手术时间、术中出血量、术后住院天数。结果:⑴观察组SBRT后肝脏转移灶明显缩小;⑵两组的ORR(66.67%vs.58.33%)、中位PFS(34.00月vs.36.00月)[HR=0.190;95%CI(0.742~1061)]及中位OS(38.52月vs.41.56月)[HR=0.069;95%CI(0.687~1.014)]均无统计学意义(P>0.05);⑶观察组的白细胞减少及神经毒性的发生率低于对照组,两组间差异具有统计学意义(P=0.004,P=0.005);两组血小板减少、腹泻、恶心呕吐及转氨酶升高的发生率差异无统计学意义(P>0.05)。⑷观察组的手术时间、术中出血量、术后住院日优于对照组,两组间差异具有统计学意义(P=0.009,P=0.001,P=0.045)。结论:对于结肠癌肝脏寡转移患者,术前行肝转移灶SBRT联合FOLFIRI化疗疗效不劣于FOLFOXIRI化疗,且不良反应轻、术后恢复快,值得临床推广。展开更多
A recent subgroup analysis of the TRIBE trial suggested that FOLFOXIRI plus bevacizumab may be a preferred option for the first-line treatment of only right-sided metastatic colorectal cancer(mCRC), regardless of RAS ...A recent subgroup analysis of the TRIBE trial suggested that FOLFOXIRI plus bevacizumab may be a preferred option for the first-line treatment of only right-sided metastatic colorectal cancer(mCRC), regardless of RAS or BRAF status. Our subanalysis of a phase Ⅱ trial of the FOLFOXIRI triplet regimen plus bevacizumab in patients with mCRC who had RAS mutant tumors showed that tumor shrinkage was better and the duration of treatment was longer in patients with leftsided tumors than in those with right-sided tumors, leading to a higher rate of conversion to surgery in mCRC patients with left-sided tumors. The early and deep responses to the triplet-regimen in patients with left-sided tumors might facilitate conversion treatment resulting in favorable survival. Our data suggest that the FOLFOXIRI plus bevacizumab might be a promising treatment for left-sided mCRC involving RAS mutant tumors.展开更多
BACKGROUND FOLFIRINOX regimen is the first-line reference chemotherapy(L1)in advanced pancreatic ductal adenocarcinoma(aPDAC).FOLFOXIRI,a schedule with a lower dose of irinotecan and no bolus 5-fluorouracil,has demons...BACKGROUND FOLFIRINOX regimen is the first-line reference chemotherapy(L1)in advanced pancreatic ductal adenocarcinoma(aPDAC).FOLFOXIRI,a schedule with a lower dose of irinotecan and no bolus 5-fluorouracil,has demonstrated efficacy and feasibility in colorectal cancer.AIM To investigate the potential clinical value of FOLFOXIRI in patients with aPDAC in routine clinical practice.METHODS Analyses were derived from all consecutive aPDAC patients treated in L1 between January 2011 and December 2017 in two French institutions,with either FOLFOXIRI(n=165)or FOLFIRINOX(n=124)regimens.FOLFOXIRI consisted of irinotecan(165 mg/m2),oxaliplatin(85 mg/m2),leucovorin(200 mg/m2)and 5-fluorouracil(3200 mg/m2 as a 48-h continuous infusion)every 2 wk.Ninety-six pairs of patients were selected through propensity score matching,and clinical outcomes of the two treatment regimens were compared.RESULTS Median overall survival was 11.1 mo in the FOLFOXIRI and 11.6 mo in the FOLFIRINOX cohorts,respectively.After propensity score matching,survival rates remained similar between the two regimens in terms of overall survival(hazard ratio=1.22;P=0.219)and progression-free survival(hazard ratio=1.27;P=0.120).The objective response rate was 37.1%in the FOLFOXIRI group vs 47.8%in the FOLFIRINOX group(P=0.187).Grade 3/4 toxicities occurred in 28.7%of patients in the FOLFOXIRI cohort vs 19.5%in the FOLFIRINOX cohort(P=0.079).FOLFOXIRI was associated with a higher incidence of grade 3/4 digestive adverse events.Hematopoietic growth factors were used after each chemotherapy cycle and the low hematological toxicity rates were below 5%with both regimens.CONCLUSION FOLFOXIRI is feasible in L1 in patients with aPDAC but does not confer any therapeutic benefit as compared with FOLFIRINOX.The low hematological toxicity rates strengthened the relevance of primary prophylaxis with hematopoietic growth factors.展开更多
文摘目的:探讨体部立体定向放疗(stereotactic Body Radiation Therapy,SBRT)联合FOLFIRI方案转化治疗对结肠癌肝脏寡转移的疗效及安全性。方法:收集我院肿瘤科及结直肠外科2014年6月-2018年6月收治的有完整资料的结肠癌肝脏寡转移患者45例,其中SBRT联合FOLFIRI转化组(观察组)21例,术前行肝转移灶SBRT及FOLFIRI方案化疗6~8周期,化疗后4~6周行左/右半结肠切除术;FOLFOXIRI转化治疗组(对照组)24例,术前行FOLFOXIRI方案化疗6~8周期,化疗后4~6周行肝转移灶切除+左/右半结肠切除术。术后两组均行补充化疗4~6周期。比较观察组SBRT前后肝脏转移灶增强MRI表现,两组的客观缓解率(ORR)、中位无进展生存期(PFS)、中位总生存期(OS)、不良反应及两组的手术时间、术中出血量、术后住院天数。结果:⑴观察组SBRT后肝脏转移灶明显缩小;⑵两组的ORR(66.67%vs.58.33%)、中位PFS(34.00月vs.36.00月)[HR=0.190;95%CI(0.742~1061)]及中位OS(38.52月vs.41.56月)[HR=0.069;95%CI(0.687~1.014)]均无统计学意义(P>0.05);⑶观察组的白细胞减少及神经毒性的发生率低于对照组,两组间差异具有统计学意义(P=0.004,P=0.005);两组血小板减少、腹泻、恶心呕吐及转氨酶升高的发生率差异无统计学意义(P>0.05)。⑷观察组的手术时间、术中出血量、术后住院日优于对照组,两组间差异具有统计学意义(P=0.009,P=0.001,P=0.045)。结论:对于结肠癌肝脏寡转移患者,术前行肝转移灶SBRT联合FOLFIRI化疗疗效不劣于FOLFOXIRI化疗,且不良反应轻、术后恢复快,值得临床推广。
文摘A recent subgroup analysis of the TRIBE trial suggested that FOLFOXIRI plus bevacizumab may be a preferred option for the first-line treatment of only right-sided metastatic colorectal cancer(mCRC), regardless of RAS or BRAF status. Our subanalysis of a phase Ⅱ trial of the FOLFOXIRI triplet regimen plus bevacizumab in patients with mCRC who had RAS mutant tumors showed that tumor shrinkage was better and the duration of treatment was longer in patients with leftsided tumors than in those with right-sided tumors, leading to a higher rate of conversion to surgery in mCRC patients with left-sided tumors. The early and deep responses to the triplet-regimen in patients with left-sided tumors might facilitate conversion treatment resulting in favorable survival. Our data suggest that the FOLFOXIRI plus bevacizumab might be a promising treatment for left-sided mCRC involving RAS mutant tumors.
文摘BACKGROUND FOLFIRINOX regimen is the first-line reference chemotherapy(L1)in advanced pancreatic ductal adenocarcinoma(aPDAC).FOLFOXIRI,a schedule with a lower dose of irinotecan and no bolus 5-fluorouracil,has demonstrated efficacy and feasibility in colorectal cancer.AIM To investigate the potential clinical value of FOLFOXIRI in patients with aPDAC in routine clinical practice.METHODS Analyses were derived from all consecutive aPDAC patients treated in L1 between January 2011 and December 2017 in two French institutions,with either FOLFOXIRI(n=165)or FOLFIRINOX(n=124)regimens.FOLFOXIRI consisted of irinotecan(165 mg/m2),oxaliplatin(85 mg/m2),leucovorin(200 mg/m2)and 5-fluorouracil(3200 mg/m2 as a 48-h continuous infusion)every 2 wk.Ninety-six pairs of patients were selected through propensity score matching,and clinical outcomes of the two treatment regimens were compared.RESULTS Median overall survival was 11.1 mo in the FOLFOXIRI and 11.6 mo in the FOLFIRINOX cohorts,respectively.After propensity score matching,survival rates remained similar between the two regimens in terms of overall survival(hazard ratio=1.22;P=0.219)and progression-free survival(hazard ratio=1.27;P=0.120).The objective response rate was 37.1%in the FOLFOXIRI group vs 47.8%in the FOLFIRINOX group(P=0.187).Grade 3/4 toxicities occurred in 28.7%of patients in the FOLFOXIRI cohort vs 19.5%in the FOLFIRINOX cohort(P=0.079).FOLFOXIRI was associated with a higher incidence of grade 3/4 digestive adverse events.Hematopoietic growth factors were used after each chemotherapy cycle and the low hematological toxicity rates were below 5%with both regimens.CONCLUSION FOLFOXIRI is feasible in L1 in patients with aPDAC but does not confer any therapeutic benefit as compared with FOLFIRINOX.The low hematological toxicity rates strengthened the relevance of primary prophylaxis with hematopoietic growth factors.
