高压氧联合化疗治疗转移性胃癌的临床研究

目的观察高压氧联合化疗治疗转移性胃癌的临床疗效及其毒副反应。方法采用随机分组和应用FLP化疗及高压氧联合FLP治疗转移性胃癌共24例,并进行近期疗效和毒副反应评价。结果高压氧联合FLP方案治疗转移性胃癌可测量病灶近期临床疗效分级评分为1.667±0.778;血液学毒性分级评分WBC为0.667±0.778,NEUT为0.500±0.520,HgB为0.333±0.492;消化系毒性分级评分恶心、呕吐为0.500±0.798,便秘为1.083±0.900。而FLP组分级评分相应分别为1.417±0.669(P(0.05),1.583±0.515(P(0.05),1.417±0.515(P(0.05),0.917±0.669(P(0.05),3.333±0.651(P(0.05),3.083±0.515(P(0.05)。结论高压氧联合FLP治疗组疗效优于FLP方案组,但差异无显著性;高压氧能明显减少FLP的血液学毒性和消化系毒性,值得临床进一步研究。     

胃癌根治术后全身静脉化疗联合腹腔区域性化疗30例分析

目的　探讨胃癌根治术后腹腔区域性化疗的疗效。方法　治疗组 3 0例胃癌行根治性切除 (D2 、D3 )手术 ,同时术中安置腹腔化疗泵 ,术后全身静脉化疗联合腹腔区域性化疗。术后每月化疗 ,第 1天用 5 Fu 15 0 0mg DDP 60mg NS10 0 0ml经腹腔化疗泵缓慢滴入 ;第 2天全身静脉化疗 ,CF 2 0 0mg/m2 × 5天 ,5 Fu 75 0mg/m2 × 5天 ,分别加入NS 5 0 0ml静脉滴注 ,MMC 4mg加入NS 2 0ml静脉注射× 1天 ,2 8天为 1个疗程 ,连用 6个疗程。对照组 3 0例胃癌根治性切除术后仅行全身静脉化疗 ,化疗方法同治疗组。结果　治疗组 3 0例 1、2、3年复发率分别为 10 .0 %、3 3 .3 %、43 .3 %。生存率分别为 93 .3 %、80 .0 %、66.6% ,对照组3 0例 ,1、2、3年复发率分别为 3 0 .0 %、63 .3 %、73 .3 %。生存率分别为 83 .3 %、60 .0 %、40 .0 %。结论　胃癌根治术后全身静脉化疗联合腹腔区域性化疗 ,其 2、3、年生存率明显高于对照组 (P <0 .0 5 ) ,其术后肿瘤复发率明显低于对照组 (P <0 .0 5 )。胃癌根治术后辅助全身静脉化疗并联合腹腔区域性化疗 ,可延长胃癌患者术后生存期 ,提高 3年生存率。     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

PFC方案化疗联合高强度聚焦超声治疗进展期胃癌的临床观察

目的:评价PFC方案化疗联合高强度聚焦超声(HIFU)治疗进展期胃癌的疗效和不良反应。方法:经病理学确诊的进展期胃癌患者60例,分A、B两组,每组30例。A组予PFC方案(紫杉醇+氟尿嘧啶+顺铂)化疗的同时行病灶部位HIFU治疗;B组单用PFC方案化疗。结果:60例均可评价疗效,A组CR5例(16.7%),PR17例(56.7%),SD4例(13.3%),PD4例(13.3%),有效率(CR+PR)73.3%,中位生存期13.9月;B组CR2例(6.7%),PR14例(46.7%),SD7例(23.3%),PD7例(23.3%),有效率53.3%,中位生存期9.6月。二组有效率无显著性差异(P>0.05),中位生存期差异有显著性(P<0.05)。主要不良反应为骨髓抑制、恶心、呕吐和脱发,二组无显著性差异(P>0.05)。结论:PFC方案化疗结合HIFU治疗进展期胃癌为一种新的疗法,其近期疗效确切,不良反应轻,患者能耐受,且能明显改善患者的中位生存期,延长患者生命,对于进展期胃癌患者如能在化疗的同时联合HIFU治疗则不失为有效治疗手段,值得深入探讨。     

沙利度胺联合化疗治疗晚期胃癌的临床观察

目的：观察沙利度胺（Thalidomide，反应停）联合奥沙利铂（L—OHP）、亚叶酸钙（CF）和氟尿嘧啶（5-FU）方案治疗晚期胃癌的临床疗效和患者的耐受性，并与单用后3种药物化疗进行比较。方法：采用随机分组的方法将45例晚期胃癌患者分为Thalidomide＋L—OHP＋CF＋5-FU方案组（联合用药组）24例与L—OHP＋CF＋5-FU方案组（化疗组）21例，观察两组的临床疗效和患者的耐受性。结果：联合用药组有效率54．2％（13／24），化疗组有效率42．9％（9／21），联合用药组有效率高于化疗组，但两组差异无统计学意义（P〉0．05）。联合用药组的疾病控制率为83．3％（20／24），化疗组为52．4％（11／21），两组差异有统计学意义（P〈0．05）。联合用药组KPS评分的改善率为75％，化疗组KPS评分的改善率为42．9％，两组差异有统计学意义（P〈0．05）。联合用药组的中位生存期及1年生存率均优于化疗组，但生存期比较差异无统计学意义（P〉0．05）。联合用药组的恶心呕吐发生率较化疗组低，差异有统计学意义（P〈0．05），但联合用药组的便秘的发生率较化疗组高，差异有统计学意义（P〈0．05）；其余毒副反应均相似。结论：与单用化疗相比，沙利度胺联合化疗方案能增加晚期胃癌患者的疾病控制率，同时改善患者的生活质量，具有较轻的消化道反应，疗效是否更优有待于进一步扩大样本量进行临床随机对照研究。     

西妥昔单抗联合化疗治疗13例晚期胃癌的临床观察

目的 观察西妥昔单抗联合化疗治疗晚期胃癌的疗效及毒副反应。方法 采用西妥昔单抗联合传统化疗药物治疗13例晚期胃癌患者,西妥昔单抗首剂负荷量400mg／m²,之后每周给予维持剂量250mg／m²,并联合常用化疗方案,化疗2～3个周期后评价疗效。结果 13例患者中,一线治疗6例,获PR 2例,SD 4例;多线治疗7例,获PR 1 例,SD 2例,PD 3例,1例疗效无法评价。主要毒副反应为骨髓抑制、胃肠道反应和皮肤黏膜反应。截至2012年12月30日,13例患者中存活2例,死亡11例,生存时间为3.9～40.8个月,中位生存时间（OS）为16.4个月（95％CI：8.4～20.4个月）。结论西 妥昔单抗联合化疗治疗国人晚期胃癌可能有较好的疗效与安全性,但需要扩大样本进一步研究。     

ELF联合紫杉醇方案治疗晚期胃癌26例的临床观察

目的:观察ELF(VP16、CF、5-Fu)联合紫杉醇方案治疗晚期胃癌的临床疗效和毒副反应。方法:紫杉醇135mg/m2-175mg/m2加入5％葡萄糖500ml静滴6小时,常规抗过敏处理,第1天给药,CF 300mg/m2,静滴2 小时,第1天给药;5-Fu 0．5静注,随后5-Fu 3．0/m2采用微量泵48小时持续滴注;VP16 120mg/m2静滴,第1、2、3 天给药。21天-28天为一周期,连用2周期以上评价疗效。结果:全组共完成化疗90个周期,无CR患者,PR 16 例(占61．5％);NC 7例(占26．9％),PD 3例(占11．5％);中位TTP为6．7个月,中位生存期为9．9个月。全组临床受益反应评价有效23例,受益率占88．5％。疼痛缓解非常明显,13例疼痛完全缓解(占76．5％),卡氏评分增加 20分以上者16例(占61．5％),体重增长7％以上者18例(占69．2％)。毒副反应:主要为骨髓抑制,Ⅲ-Ⅳ度白细胞减少8例(占30．8％);呕吐反应轻,Ⅰ-Ⅱ度18例(占69．3％),无治疗相关死亡。结论:对于晚期胃癌患者采用ELF联合紫杉醇方案化疗,能取得较理想疗效,临床受益率高,毒副反应轻,能明显改善患者的生存质量。     

ELF联合紫杉醇方案治疗晚期胃癌26例的临床观察

目的:观察ELF(VP16、CF、5-Fu)联合紫杉醇方案治疗晚期胃癌的临床疗效和毒副反应.方法:紫杉醇135mg/m2～175mg/m2加入5%葡萄糖500ml静滴6小时,常规抗过敏处理,第1天给药,CF 300mg/m2,静滴2小时,第1天给药;5-Fu 0.5静注,随后5-Fu 3.0/m2采用微量泵48小时持续滴注;VP16 120mg/m2静滴,第1、2、3天给药.21天～28天为一周期,连用2周期以上评价疗效.结果:全组共完成化疗90个周期,无CR患者,PR 16例(占61.5%);NC 7例(占26.9%),PD 3例(占11.5%);中位TTP为6.7个月,中位生存期为9.9个月.全组临床受益反应评价有效23例,受益率占88.5%.疼痛缓解非常明显,13例疼痛完全缓解(占76.5%),卡氏评分增加20分以上者16例(占61.5%),体重增长7%以上者18例(占69.2%).毒副反应:主要为骨髓抑制,Ⅲ～Ⅳ度白细胞减少8例(占30.8%);呕吐反应轻,Ⅰ～Ⅱ度18例(占69.3%),无治疗相关死亡.结论:对于晚期胃癌患者采用ELF联合紫杉醇方案化疗,能取得较理想疗效,临床受益率高,毒副反应轻,能明显改善患者的生存质量.     

含替吉奥联合化疗方案治疗进展期胃癌研究的进展

替吉奥胶囊（Ｓ-１）是替加氟及优福定的升级换代产品,使用替吉奥联合化疗方案治疗晚期胃癌在不同的临床研究中取得了初步肯定的治疗效果,毒副作用小,疗效确切,给药方便。本文就含替吉奥联合化疗方案治疗进展期胃癌的研究进展作一综述。     

含大剂量表阿霉素的联合化疗方案治疗晚期胃癌

目的　研究含大剂量表阿霉素的联合化疗（ＥＣＬＦ） 方案在治疗晚期胃癌中的作用。　方法　１９９８ 年５月～１９９８ 年１２ 月,３０ 例晚期胃癌随机分组治疗。　结果　大剂量表阿霉素组（９０ ｍｇ／ｍ２ 缓慢静脉推注） 优于常规剂量组（５０ ｍｇ／ｍ２） 。近期有效率分别为５５ ％ 、４０％ ,但Ｐ＞ ００５ 。除腹泻外,两组的Ⅲ～Ⅳ级不良反应均无显著性差异（ Ｐ＞ ００５） 。　结论　含大剂量表阿霉素的联合化疗方案治疗晚期胃癌,能提高疗效。     

Paclitaxel chemotherapy for the treatment of gastric cancer

A comprehensive review of phase I and phase II clinical trials of paclitaxel and paclitaxel-containing chemotherapy regimens for advanced gastric cancer was performed. Response rates, median progression-free survivals, and median overall survivals were examined, together with the treatment regimens and the numbers of patients registered in each trial. Although paclitaxel monotherapy produced considerable improvement in tumor response and prognosis, combination doublet or triplet chemotherapy with fluoropyrimidines and/or platinum compounds showed better results than the paclitaxel monotherapy. With regard to the schedule of paclitaxel administration, weekly injection seemed to show less toxicity and better results than administration every 3 weeks. Adjuvant therapies, chemoradiation therapies, and paclitaxel treatment for gastric ascites were also investigated and are discussed.     

塞来昔布联合化疗治疗晚期胃癌的疗效分析

目的 观察选择性环氧合酶2（cylooxygenase-2,COX-2）抑制剂塞来昔布联合多西他赛和替吉奥方案治疗晚期胃癌的临床疗效和不良反应。方法 将50例晚期胃癌患者随机分为两组,试验组25例采用塞来昔布联合多西他赛和替吉奥方案化疗,对照组25例给予单纯多西他赛和替吉奥方案化疗,2个周期治疗后评估两组近期疗效和不良反应,同时观察生存情况。结果 完成2个周期治疗后,试验组有效率为60%,疾病控制率为96%,对照组分别为52%和92%,两组比较差异均无统计学意义（P＞0.05）;两组治疗后不良反应发生率差异亦无统计学意义（P＞0.05）;试验组生活质量改善率高于对照组,差异有统计学意义（60% vs 32%,P＜0.05）。试验组和对照组中位无疾病进展生存期差异亦有统计学意义（7.6个月vs 6.3个月,P＜0.05）;但中位总生存期差异无统计学意义（13.6个月vs 12.2个月,P＞0.05）。结论 塞来昔布联合多西他赛和替吉奥治疗晚期胃癌与单用化疗疗效相当,无疾病进展生存期延长,可改善生活质量且不增加不良反应。     

胃动脉插管化疗栓塞联合腹腔化疗治疗进展期胃癌

目的:为探讨对晚期进展期胃癌,进行胃动脉化疗栓塞并腹腔化疗双途径给药的可行性及临床疗效.方法:无法手术切除的进展期胃癌98例,随机分为三组,A组行胃动脉化疗栓塞并腹腔化疗;B组行腹腔化疗;c组行静脉化疗.结果:胃动脉化疗栓塞是可行的.A、B、C三组有效率分别为71.88%、38.7%和14.3%.A组与B、C组比较有明显差异(P<0.01).A组有5例完全缓解,且生存期延长.不良反应以胃肠道毒性和骨髓抑制为主.A组术后胃粘膜有损伤,四周后可恢复正常.结论:胃动脉化疗栓塞并腹腔化疗双途径给药是治疗晚期进展期胃癌的有效方法.     

Phase II study of docetaxel and cisplatin combination chemotherapy in metastatic gastric cancer

Purpose: Docetaxel, as a single agent, has demonstrated activity in patients with advanced gastric cancer and cisplatin has shown lack of overlapping toxicities with docetaxel. Therefore, we conducted a phase II study to assess the efficacy and the toxicity of a combination regimen of docetaxel plus cisplatin in patients with advanced gastric cancer who have never been treated with palliative chemotherapy. Methods: Ninety-two patients with metastatic gastric cancer were enrolled from April 2000 to March 2004. Patients with histologically confirmed gastric adenocarcinoma, at least one bi-dimensionally measurable lesion, no prior palliative chemotherapy and at least 6 months from the end of adjuvant chemotherapy were eligible for study entry. Docetaxel 75 mg/m² and cisplatin 75 mg/m² were given on day 1. The cycle was repeated every 3 weeks. The objective response was evaluated after three cycles of chemotherapy. Toxicity was assessed according to the National Cancer Institute common toxicity criteria scale version 2.0. Results: In total, 401 cycles were administered, with a median of 5 cycles per patient (range 1–9 cycles). The median age was 56 years (range 31–76). Eighty-six patients were evaluable for treatment response. The objective response rate was 43.5% (95% CI, 33.4–53.6) with one complete response and 39 partial responses. Twenty patients (21.7%) had stable disease and 26 patients (28.3%) had a progression. The median time to progression was 7.0 months (95% CI, 5.0–9.0) and the median overall survival was 11.5 months (95% CI, 9.5–13.4). The chemotherapy was generally well tolerated and the most common grade 3–4 toxicities were neutropenia (17.4%), nausea/vomiting (13.0%) and diarrhea (7.6%). Conclusion: The combination chemotherapy of docetaxel with cisplatin in advanced gastric cancer was tolerable for most patients and showed a promising antitumor activity as a first-line therapy.Keon Woo Park and Jin Seok Ahn contributed equally to this work.     

A long-term survivor of metastatic gastric cancer treated by chemotherapy: case report

A long-term survivor of advanced gastric cancer with multiple metastases to the liver treated by chemotherapy is described. Chemotherapy comprising a combination of uracil and tegafur with mitomycin C achieved a complete response in the patient which lasted for approximately four years. Four years after initiation of the chemotherapy, a unique form of cancer recurrence occurred on the skin, showing infiltrative erythema. Cancer metastases developed further despite more treatment, and the patient died of generalized metastasis four years six months after the initiation of chemotherapy. It is significant that, at autopsy, no cancer cells were revealed in the primary lesion or in the liver which had been present before the initial chemotherapy.     

紫杉醇联合卡培他滨一线治疗晚期胃癌的临床观察

目的　观察紫杉醇联合卡培他滨一线治疗晚期胃癌的疗效和毒副反应。方法　晚期胃癌患者２０例,给予紫杉醇８０ｍｇ／ｍ２静脉滴注,第１、８天;卡培他滨１０００ｍｇ／ｍ２,分早晚各口服１次,第１～１４天;２１天为１周期。每２周期评价疗效。结果　１９例可评价疗效,获ＣＲ１例,ＰＲ７例,总有效率（ＲＲ）为４２.１％。中位无进展生存期和总生存期分别为４.８个月和９.７个月,１年生存率为３６.８％。主要的毒副反应为血液学毒性、脱发和手足综合症。结论　紫杉醇联合卡培他滨治疗晚期胃癌安全、有效,值得临床进一步应用。     

重组人血管内皮抑素联合化疗一线治疗转移性结直肠癌的临床观察

目的　探讨重组人血管内皮抑素（恩度）联合化疗一线治疗转移性结直肠癌的安全性与疗效。方法　１６例转移性结直肠癌患者,在常规化疗基础上联合恩度进行一线治疗,化疗方案包括ＸＥＬＯＸ方案、ＸＥＬＩＲＩ方案和卡培他滨单药,恩度１５ｍｇ／天静滴,第１～１４天。３周为１周期,共进行４～６个周期。结果　１６例患者共完成８３个周期的治疗,平均５.２个周期,均可评价不良反应和客观疗效。主要不良反应为骨髓抑制、胃肠道反应、神经毒性和手足综合征,多为１～２级,且与化疗相关。疗效评价获ＰＲ６例,ＳＤ７例,ＰＤ３例,客观缓解率为３７.５％,疾病控制率为８１.３％;中位无进展生存期为９.２０个月（９５％ＣＩ：３.３９～１５０１）,中位生存期为１５.３个月（９５％ ＣＩ：６.１８～２４.４２）;与治疗前相比,治疗后ＣＥＡ（Ｐ＝０.０４９）和ＣＡ１９９（Ｐ＝０.０４８）均显著下降。结论　恩度联合化疗一线治疗转移性结直肠癌安全有效。     

尼妥珠单抗联合DCF方案治疗晚期胃癌的临床观察

目的 观察尼妥珠单抗联合DCF方案治疗晚期胃癌的近期疗效及不良反应。方法 36 例晚期胃癌患者分为治疗组和对照组。治疗组（n =17）采用尼妥珠单抗联合DCF方案治疗：尼妥珠单抗200mg,每周1 次,连用6 个周期,之后同剂量每2 周1 次进行巩固治疗,至病情进展停用;多西他赛60mg/m2,静脉滴注,dl;顺铂60mg/m2,静脉滴注,dl;氟尿嘧啶600mg/m2,持续静脉输注120h。对照组（n=19）仅用DCF 方案治疗,同治疗组。结果 36 例患者均可进行评价。治疗组有效率（RR）为64.8 %,疾病控制率（DCR）为82.4%;对照组RR为31.6%,DCR为47.4％。两组间RR、DCR 比较差异均有统计学意义（P＜0.05）。治疗组与对照组主要的毒副反应有疲乏、白细胞减少、恶心呕吐、脱发等,两组间比较差异无统计学意义（P＞0.05）。结论 尼妥珠单抗联合DCF 方案治疗晚期胃癌安全有效,值得进一步扩大样本研究。     

Current status and future prospects of chemotherapy for metastatic gastric cancer: a review

Although many randomized trials of chemotherapy for metastatic gastric cancer have been reported during the past two decades, no standard regimens worldwide have been established yet. Reference arms vary depending on the region and cultural differences. To date, a combination of 5-fluorouracil (5-FU) and cisplatin is most widely used. However, no confirmation of survival advantage over single-agent 5-FU in a randomized trial has been proved yet, and there remain limitations of efficacy results in older-generation regimens. Recently developed new agents such as irinotecan, taxanes (paclitaxel and docetaxel), and new oral fluorouracil (S-1 and capecitabine) provided more promising results: a response rate over 50% and median survival time (MST) over 10 months in their preliminary combination studies. These newer combination regimens are now being investigated in various randomized phase III studies, which will clarify whether the newer-generation regimens provide survival advantage over older-generation regimens. The MST of the new standard should exceed 11 months to be considered a definite improvement, and overall survival seems to be a more desirable primary end point than progression-free survival in a randomized trial. Molecular targeting agents are another concern to improve the treatment outcomes of this disease and are now under investigation in combination with conventional cytotoxic agents. Both clinical and biological research will be more important in future studies.