紫杉醇联合顺铂和氟尿嘧啶治疗进展期胃癌的疗效观察

目的:研究紫杉醇(PTX)联合顺铂(DDP)和氟尿嘧啶(5-Fu)治疗进展期胃癌的疗效及不良反应,以期提高进展期胃癌手术的根治性切除率,改善病人的预后,为胃癌患者的治疗提供理论依据,进而丰富进展期胃癌治疗方法。方法:36例经病理学或细胞学确诊为进展期胃癌的患者,给予紫杉醇35 mg/m2,第1、8天静滴,顺铂20 mg/(m2·d),第1、2、3天静滴,氟尿嘧啶500 mg/m2持续静滴,第1~5天,28天为1个周期,连用2个周期后评价疗效。按照实体瘤疗效评价标准(RECIST)评价客观疗效,按世界卫生组织(WHO)标准评价不良反应。结果:所有患者均接受2个周期的化疗后进行治疗效果的评价。36例进展期胃癌中2例达到CR,17例PR,9例SD,8例PD,总有效率为52.8%,临床受益率为72.2%。镜检25例(69.4%)出现组织病理学改变,如肿瘤组织坏死、淋巴细胞浸润、癌细胞凋亡、以及间质水肿纤维组织增生等。主要毒性反应为骨髓抑制、消化道反应和脱发,其中白细胞减少发生率为47.2%,恶心、呕吐的发生率为41.7%,脱发反应发生率为55.6%。全组未见化疗相关性死亡。结论:紫杉醇联合顺铂和5-氟尿嘧啶的联合化疗方案是治疗进展期胃癌具有较好的总有效率和临床受益率,毒副反应可耐受,可使肿瘤组织产生显著的组织病理学改变,可改善患者的生存质量,是治疗进展期胃癌有效安全的方法之一,值得进一步研究。

The Effect of Paclitaxel Combined with Cisplatin and 5- fluorouracil forPatients with Advanced Gastric Cancer

Objective:To observe the efficacy and the adverse effects of paclitaxel (PTX) combined with cisplatin (DDP) andfluorouracil (5-Fu) for the treatment of patients with advanced gastric carcinoma, in order to increase the overall curative resection rate,improve prognosis and provide a theoretical basis for the treatment of patients with gastric carcinoma, enrich the methods of treating thisdisease.Methods:36 patients with advanced gastric carcinoma diagnosed pathologically were enrolled into the study, and they weretreated with PTX 35 mg·m-2 dropping day 1 and day 8, DDP 20 mg·m-2 dropping day 1, day 2 and day 3, 5-Fu 500 mg·m-2 dropping day1-5, and this regimen is one 28-day treatment cycle. The short-time chemotherapy efficacy and toxicity were valuated after 2 cycles. Theefficacy was evaluated according to response evaluatione criteria in solid tumors (RECIST) standard and toxicity was evaluated accordingto world health organization (WHO) standard.Results:All the patients completed chemotherapy for two circles. The result showed thatthere were 2 cases CR, 17 cases PR, 9 cases SD and 8 cases PD, the total effective rate was 52.8 % in the 36 patients with advancedgastric cancer, and clinical benefit rate was 72.2 %. Microscopically, 25 cases (69.4 %) showed varied histopathological changes, whichincluded tumor necrosis, lymphocyte infiltration, residual cancer cells apoptosis, interstitial edema, and fibrosis.The main toxicities weremyelosuppression, alimentary canal reactions and alopecia, the incidence of leucopenia was 47.2 %, nausea/vomiting 41.7 % andalopecia 55.6 %. No chemotherapy-related death occurred.Conclusion:The regmiens of PTX combined with DDP and 5-Fu is aneffective method on curing the patients with advanced gastric carcinoma which have high total effective rate and clinical benefit rate, cancause significant histopathological changes, and adverse reactions can be tolerated. Meanwhile, it could improve life quality of thesepatients, so this regimen is worth while of further study.