奥沙利铂联合氟尿嘧啶及亚叶酸钙治疗转移性大肠癌120例疗效评价

目的观察三联疗法治疗转移性大肠癌的临床效果、毒性反应以及患者依从性。方法选择2012年4月至2013年8月就诊的转移性大肠癌患者120例,随机分为A组B组,各60例。A组采用改良的FOLFOX7方案,第1天予奥沙利铂（L-OHP）130 mg/m2＋5%葡萄糖注射液500 m L,静脉滴注4 h;后静脉滴注亚叶酸钙（CF）200 mg＋0.9%氯化钠注射液250 m L,2 h内滴完;再持续静脉滴注2 600 mg/m2氟尿嘧啶（5-FU）46 h;重复给药不超过12次。B组第1天予L-OHP 200 mg＋5%葡萄糖注射液2 500 m L,静脉滴注2 h;同时静脉滴注2 h CF 200 mg/m2＋0.9%氯化钠注射液250 m L;待上述2种药物同时结束后,再连续静脉滴注6 h 5-FU 300 mg/m2＋0.9%氯化钠注射液500 m L。结果 A组患者完全缓解8例,部分缓解20例,总有效率为46.67%（28/60）,高于B组的26.67%（χ2=5.17,P〈0.05）。2组均未发现Ⅳ级严重毒性反应,B组严重毒性反应发生率高于A组,但无统计学差异（P〉0.05）。化学治疗药物毒性最主要表现为脱发,2组均为95.00%;其次是神经毒性和恶心/呕吐,A、B两组的发生率分别为60.00%比65.00%和58.33%比65.00%,但差异无统计学意义（P〉0.05）。A组完全依从,没有脱落病例,B组有3例患者中途退出研究,脱落率为5.00%,高于A组,但无显著性差异（P〉0.05）。结论奥沙利铂联合氟尿嘧啶、亚叶酸钙治疗转移性大肠癌的疗效确切,特别是经改良后的FOLFOX7方案更提高了临床疗效,提高了患者治疗依从性,药物毒性反应常见且轻微,值得临床推广。

Effect Observation on Triple Therapy of Oxaliplatin Combined with Fluorouracil and Calcium Folinate for Treating 120 Cases of Metastatic Colorectal Cancer

Objective To observe the clinical effect,toxic effects and patient  s compliance of the triple therapy of oxaliplatin combined with fluorouracil and calcium folinate（ CF） for metastatic colorectal cancer. Methods 120 cases of metastatic colorectal cancer in our hospital from April 2012 to August 2013 were chosen and randomly divided into the group A and B according to the order of admission and the principle of informed consent, 60 cases in each group. The group A adopted the modified FOLFOX7 scheme. Oxaliplatin（ L- OHP） 130 mg / m2 plus 5% glucose 500 m L was intravenous dripped for 4 h; then CF 200 mg plus 0. 9% sodium chloride solution250 m L was given by intravenous drip for 2 h; finally fluorouracil（ 5- FU） 2 600 mg / m2 was given by intravenous drip for 46 h. The repeat administration did not exceed 12 times. The group B was given L- OHP 200 mg plus 5% glucose 2 500 m L by intravenous drip for 2 h on 1 d; at the same time, CF 200 mg / m2 plus 0. 9% sodium chloride solution 250 m L by intravenous drip for 2 h; after that5- FU 300 mg / m2 plus 0. 9% sodium chloride solution 500 m L by continuously intravenous drip for 6 h. The clinical efficacy,compliance and drug toxicity reactions were observed in the two groups. Results In the group A,the complete remission（ CR） was in 8 cases,partial remission（ PR） was in 20 cases, the total effective rate was 46. 67%（ 28 / 60）, which was higher than 26. 67% in the group B（ χ^2= 5. 17, P〈0. 05）. No grade Ⅳ of serious toxicity reaction were found in 2 groups. The occurrence rate of serious toxicity reactions in the group B was 10. 0%, which was higher than that in the group A, but there was no statistical difference（ P〉0. 05）. The main chemotherapy drug toxicity manifestations were hair loss,its occurrence rate in the two groups was 95. 00%,followed by the neurotoxicity and nausea / vomiting,their occurrence rates in the groups A and B were 60. 00%,65. 00% and 58. 33%,65. 00%,respectively,but without tatistically significant differ