DCF方案治疗晚期胃癌临床观察

目的 观察DCF方案治疗晚期胃癌的疗效及毒副反应.方法 选取晚期胃癌患者45例,DCF方案为:多西他赛75 mg/m2 静脉滴注第1天,顺铂75 mg/m2 分2～3 d静脉滴注,5-氟尿嘧啶(5-Fu) 500 mg/m2静脉滴注第1～5天.每21 d为1周期,所有患者至少接受4个周期治疗.结果 完全缓解2例、部分缓解16例、稳定13例、进展14例,总有效率40.0%.临床获益31例(68.9%).疾病无进展时间为(4.28±0.31)个月,生存期为(9.03±0.55)个月.主要毒副反应为骨髓抑制、恶心、呕吐、脱发、肝肾功能损害.结论 DCF方案治疗晚期胃癌疗效较好,毒副反应较常见,骨髓毒性较明显但可耐受.     

以多西他赛为基础的三药联合与两药联合一线治疗晚期胃癌的疗效对比研究

目的比较以多西他赛为基础的DCF三药联合方案与DF/DX两药联合方案一线治疗晚期胃癌的临床疗效和毒副作用。方法收集我科104例一线化疗以多西他赛为基础的晚期胃癌患者,其中DCF三药联合方案组共53例、DF/DX两药联合组共51例,所有患者至少接受以上方案2个周期,评价疗效。结果两组有效率、疾病控制率、中位总生存时间及毒副作用发生率比较,差异均无统计学意义(P>0.05);DCF三药联合组中位无疾病进展时间(PFS)高于DF/DX两药联合组,差异有统计学意义(P=0.016)。结论 DCF三药联合方案治疗晚期胃癌的PFS较长,但对于总生存期并无明显延长,且毒副作用较大,年龄不高、化疗耐受好的患者可考虑DCF三药联合,DF/DX两药联合方案也可以作为晚期胃癌的有效化疗方案选择。     

香菇多糖联合FOLFOX4化疗方案治疗对中晚期胃癌患者血清VEGF、IL-10和生活质量的影响

目的:探讨香菇多糖联合FOLFOX4化疗方案对中晚期胃癌患者血清血管内皮生长因子(vascular endothelial growth factor,VEGF)、白介素-10(interleukin-10,IL-10)和生活质量的影响.方法:选取2013-10/2014-10南华大学附属第一医院收治的116例中晚期胃癌患者作为研究对象,按照治疗方案分为对照组56例和观察组60例.对照组给予奥沙利铂+亚叶酸钙+5-氟尿嘧啶的FOLFOX4方案治疗,在此基础上,观察组联合应用香菇多糖治疗.疗程结束后,比较两组患者肿瘤近期疗效、不良反应、血清VEGF、IL-10水平及生活质量.结果:疗程结束后,观察组和对照组肿瘤治疗近期有效率分别为65.0%和55.4%(P0.05).治疗期间,与对照组相比,观察组Ⅰ-Ⅱ度中性粒细胞减少症及骨髓抑制发生率显著降低(P0.05),而胃肠道反应、肝功能损害的发生率比较无统计学意义(均P0.05).治疗后,观察组VEGF、IL-10水平均明显低于对照组(P0.05).随访6 mo,观察组主观症状、心理状态、日常生活及社会活动状态、总分评分均明显高于对照组(P0.05),而两组患者生理状态评分比较差异无统计学意义(P0.05).结论:香菇多糖联合FOLFOX4化疗方案是中晚期胃癌的有效治疗方案,具有较高的近期有效率,而且能够减少不良反应,降低血清VEGF、IL-10水平,提高生活质量,值得临床上进一步研究.     

注射用黄芪多糖联合EOF方案治疗晚期胃癌疗效分析

[目的]对注射用黄芪多糖联合EOF方案治疗晚期胃癌的疗效进行临床分析.[方法]将86例经病理学证实的晚期胃癌患者随机分为治疗组与对照组.对照组43例予以EOF方案化疗;治疗组43例除采用与对照组同等剂量EOF方案外,化疗时联合应用注射用黄芪多糖.观察2组的近期疗效、不良反应、生活质量、免疫功能变化.[结果]治疗组与对照组有效率分别为55.8％和41.9％,治疗组在提高疗效、减轻不良反应、提高生活质量、增强免疫功能方面均优于对照组.2组比较差异有统计学意义（P＜0.05）.[结论]EOF方案联合注射用黄芪多糖治疗晚期胃癌可以提高疗效,减轻不良反应,增强免疫功能,提高生活质量.     

香菇多糖注射液配合紫杉醇脂质体化疗方案对晚期非小细胞肺癌疗效的观察

目的探索香菇多糖配合紫杉醇脂质体对晚期非小细胞肺癌治疗的价值。方法将68例晚期非小细胞肺癌患者随机分为治疗组和对照组。两组均给予紫杉醇脂质体化疗方案,治疗组加用香菇多糖。观察两组的疗效及不良反应情况。结果两组的疗效无明显差异,但治疗组的不良反应明显低于对照组。结论香菇多糖联合紫杉醇脂质体治疗晚期非小细胞肺癌改善了患者的生存质量,减轻了不良反应。     

改良DCF方案治疗晚期胃癌33例临床观察

［摘要］　目的　观察改良DCF方案治疗晚期胃癌的临床疗效及毒副反应。方法　33例患者均经病理及影像学确诊为转移或复发性晚期胃癌,给予改良DCF方案化疗,至少完成2个周期治疗后评估临床疗效及不良反应。结果　完全缓解（CR）1例,部分缓解（PR）16例,有效率(CR+PR)为51.5%。主要不良反应有骨髓抑制,恶心、呕吐、腹痛、腹泻等消化道反应。结论　改良DCF方案治疗晚期胃癌临床疗效较好,毒副反应可耐受。     

DSOX方案与DCF方案对晚期胃癌患者预后及血清指标影响的对比研究

目的对比分析DSOX方案(多西他赛+奥沙利铂+替吉奥)与DCF方案(多西他赛+顺铂+氟尿嘧啶)对晚期胃癌患者预后及血清指标的影响。方法将2012年1月至2016年8月我院收治的72例晚期胃癌患者随机分为观察组(36例)与对照组(36例),观察组患者接受DSOX方案治疗,对照组患者接受DCF方案治疗。对比分析两组的血清肝肾功能指标、胃癌相关肿瘤标志物,以及无进展生存时间(PFS)、总生存时间(OS)等。结果 (1)化疗前,两组患者血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、总胆汁酸(TBA)、前白蛋白(PA)、尿素氮(BUN)、尿酸(UA)、肌酐(CR)相比差异无统计学意义(P0.05)。两组血清ALT、AST、TBIL、TBA在化疗后均显著升高,PA在化疗后均显著下降,前后比较差异有统计学意义(P0.05);观察组血清BUN、UA、CR化疗前后比较差异无统计学意义(P0.05),而对照组血清BUN、UA、CR在化疗后均显著升高(P0.05)。化疗后,观察组血清ALT、AST、TBIL、TBA、BUN、UA、CR显著低于对照组,PA显著高于对照组(P均0.05)。(2)化疗前,两组癌胚抗原(CEA)、糖类抗原72-4(CA72-4)、糖类抗原19-9(CA19-9)相比差异无统计学意义(P0.05)。观察组与对照组血清CEA、CA72-4、CA19-9在化疗后显著下降(P0.05)。化疗后,观察组血清CEA、CA72-4、CA19-9显著低于对照组(P0.05)。(3)观察组PFS显著长于对照组(P0.05)。结论 DSOX方案治疗晚期胃癌的疗效优于DCF方案,且其肝肾毒性更轻。     

3种常用联合化疗方案一线治疗晚期胃癌的疗效和安全性比较

目的比较3种常用联合化疗方案一线治疗晚期胃癌的临床疗效和安全性。方法回顾性研究2010年1月至2013年6月期间一线接受联合化疗的晚期胃癌患者46例。其中奥沙利铂联合氟尿嘧啶（mFOLFOX6）方案治疗14例;伊立替康联合氟尿嘧啶（FOLFIRI）方案治疗12例;多西他赛、奥沙利铂或顺铂联合氟尿嘧啶（DOF/DCF）方案治疗20例。化疗2月后评价疗效,化疗期间监测药物不良反应,对无进展生存时间（PFS）和总生存期（OS）进行随访。结果 3种联合化疗的总体客观缓解率为23.9%,总体疾病控制率为82.6%。mFOLFOX6、FOLFIRI、DOF/DCF治疗的患者中位OS分别为20月、11.5月和26月（P=0.043）。分层分析显示对于复发后一线治疗的患者,3种化疗方案没有统计学差异,而对于初治的患者,一线使用FOLFIRI或mFOL-FOX6或DOF/DCF的PFS分别为2.5月、5.5月和7月,中位OS分别为4.5月、19月和14月（P=0.020）。全部Ⅲ~Ⅳ度药物不良反应发生率在mFOLFOX6组（21.4%）较低,但无统计学差异。结论 3种化疗方案用于晚期胃癌均有效且可耐受,但对于初治患者mFOLFOX6或DOF/DCF较FOLFIRI具有更多的生存获益。     

甲地孕酮联合化疗治疗高龄晚期胃癌78例

胃癌是指发生于胃黏膜的恶性肿瘤,其发病率高居各类肿瘤之首[1].目前大多数胃癌确诊时已是晚期,已经失去手术治疗的最佳时期,而化疗被证明能提高晚期胃癌的存活率和末期生活品质,然而全身化疗所引起毒副作用将不可避免地加重诸如食欲不振、体重下降和营养不良等并发症[2].甲地孕酮(MA)能改善食欲和氮的正平衡,显著改善患者的生活质量[3].本文运用MA到晚期胃癌患者的EOF及DCF方案中,获得了较为满意的临床疗效.     

贝伐珠单抗联合紫杉醇脂质体方案化疗治疗晚期胃癌的临床效果

目的:探讨贝伐珠单抗联合紫杉醇脂质体方案化疗治疗晚期胃癌的临床效果及安全性.方法:抽取2012-01/2014-01入新疆医科大学附属肿瘤医院治疗的晚期胃癌患者60例作为研究对象,将患者随机分为对照组和观察组,对照组给予紫杉醇脂质体联合卡培他滨方案化疗,观察组在对照组的基础上联合贝伐珠单抗治疗,分别对比观察两组患者的临床疗效和不良反应.结果:观察组有效率为68.7%,对照组为54.4%,差异具有统计学意义(P0.05).观察组骨髓抑制和胃肠反应的发生率分别为12.3%、2.4%,与对照组比较,差异无统计学意义(P0.05).观察组1年生存率达46.9%;对照组生存率达44.8%;两组患者的生存率差异无统计学意义(冇2=1.02,P0.05).结论:贝伐珠单抗联合紫杉醇脂质体方案化疗晚期胃癌可提高临床疗效,值得进一步推广应用.     

Docetaxel and Cisplatin Plus Fluorouracil compared with Modified Docetaxel, Cisplatin, and 5-Fluorouracil as first-line therapy for advanced gastric cancer: a retrospective analysis of single institution

Gastric cancer is the second most common among cancer-related deaths in the world. Systemic chemotherapy for patients with gastric cancer has limited impact on overall survival. We performed a retrospective analysis of the efficacy and side effects of Docetaxel and Cisplatin Plus Fluorouracil (DCF) versus Modified-Dose Docetaxel, Cisplatin, and 5-Fluorouracil (mDCF) in the metastatic gastric cancer with first-line chemotherapy treated patients. Retrospectively were reviewed 107 locally advanced or metastatic gastric cancer patients who were treated DCF or mDCF as first-line treatment from June 2007 to August 2011 in Dicle University Hospital, Department of Medical Oncology.The DCF protocol included 75 mg/m2 docetaxel and cisplatin on day 1 and 750 mg/m2/day 5-FU infusion for 5 days, repeated every 3 weeks. The mDCF protocol included 60 mg/m2 docetaxel and cisplatin on day 1 and 600 mg/m2 5-Fluorouracil continuous infusion per day on days 1-5, every 3 weeks.Patients were treated using DCF arm 85 (M: 56, F: 29), the mDCF arm 22 (M: 13, F: 9) After treatment toxicities were: Grade III-IV neutropenia (48.2% vs 13.6% p=0.003), anemia (21.2% vs 4.5% p=0.06), nausea (44.7% vs 13.6% p=0.008) and vomiting (31.8% vs 4.5%, p=0.01) was higher in the DCF arm. Other toxicities profile was similar in both groups (p>0.05). The rate of response was similar in both arm. Among patients with the DCF and mDCF arm rate complete response (10.3% vs 6.7%, p>0.05), partial response (35.3% vs 40.0%, p>0.05), stable disease (32.4% vs 33.3%, p>0.05), progressive disease (22.1% vs 20.0%, p>0.05) and overall response (45.6% vs 46.7%, p>0.05) did not have a statistically difference (p>0.05). Progression-free survival (PFS) and overall survival (OS) were more favorable in the DCF arm than mDCF arm, but the difference was not significant statistically (9.9 vs 8.6, 7.4 vs 6.5 p>0.05)In conclusion, the response rate, median PFS and median OS are similar in both arms, while the mDCF regimen are more favorable than the DCF for toxicity profile regimen in advanced gastric cancer patients who were undergoing first-line palliative treatment. Therefore, a prospective and larger clinical trials are needed.     

A multi-institutional prospective study of lentinan in advanced gastric cancer patients with unresectable and recurrent diseases: effect on prolongation of survival and improvement of quality of life. Kanagawa Lentinan Research Group.

BACKGROUND/AIMS: Lentinan is one of the host-mediated anti-cancer drugs which has been shown to affect host defense immune systems. Although the mechanisms involved in the antitumor effects of lentinan have been reported experimentally, the clinical outcome on prolongation of survival and improvement of quality of life in gastric cancer patients with unresectable or recurrent diseases has yet to be clarified. The aim of the present study was to investigate whether administration of lentinan prolonged survival or improved quality of life in these patients. METHODOLOGY: A multi-institutional randomized prospective protocol, consisting of patients administered tegafur and cisplatin (control group), and patients administered lentinan, tegafur and cisplatin (lentinan group), was performed. Quality of life was investigated using a questionnaire survey. RESULTS: Median survival was significantly longer in the lentinan group than in the control group (297 days vs. 199 days, p = 0.028). One-year survival rate was greater in the lentinan group than in the control group (49.1% vs. 0%). Total QOL score, especially appetite and sleep quality, was significantly improved with the administration of lentinan. CONCLUSIONS: Lentinan is considered to prolong survival and improved quality of life when gastric cancer patients with unresectable or recurrent diseases are treated in combination with other chemotherapeutic agents.     

Chemotherapy and resection for gastric cancer with synchronous liver metastases

AIM: To investigate the effect of surgery and chemotherapy for gastric cancer with multiple synchronous liver metastases (GCLM). METHODS: A total of 114 patients were entered in this study, and 20 patients with multiple synchronous liver metastases were eligible. After screening with preoperative chemotherapy, 20 patients underwent curative gastrectomy and hepatectomy for GCLM; 14 underwent major hepatectomy, and the remaining six underwent minor hepatectomy. There were 94 patients without aggressive treatment, and they were in the non-operative group. Two regimens of perioperative chemotherapy were used: S-1 and cisplatin (SP) in 12 patients, and docetaxel, cisplatin and 5-fluorouracil (DCF) in eight patients. These GCLM patients were given preoperative chemotherapy consisting of two courses chemotherapy of SP or DCF regimens. After chemotherapy, gastrectomy and hepatectomy were preformed. Evaluation of patient survival was by follow-up contact using telephone and outpatient records. All patients were assessed every 3 mo during the first year and every 6 mo thereafter. RESULTS: Twenty patients underwent gastrectomy and hepatectomy and completed their perioperative chemotherapy and hepatic arterial infusion before and after surgery. Ninety-four patients had no aggressive treatment of liver metastases because of technical difficulties with resection and severe cardiopulmonary dysfunction. In the surgery group, there was no toxicity greater than grade 3 during the course of chemotherapy. The response rate was 100% according to the Response Evaluation Criteria in Solid Tumors Criteria. For all 114 patients, the overall survival rate was 8.0%, 4.0%, 4.0% and 4.0% at 1, 2, 3 and 4 years, respectively, with a median survival time (MST) of 8.5 mo (range: 0.5-48 mo). For the 20 patients in the surgery group, MST was 22.3 mo (range: 4-48 mo). In the 94 patients without aggressive treatment, MST was 5.5 mo (range: 0.5-21 mo). There was a significant difference between the surgery and unresectable patients (P = 0.000). Thr     

The resection of non-hepatic intraabdominal recurrence of gastric cancer

BACKGROUND/AIMS: Surgical resection of hepatic or pulmonary metastases from gastrointestinal cancer has been recognized as a curative modality in some patients. However, the role and outcome of the surgical management of a non-hepatic intraabdominal recurrence of gastrointestinal cancer have not been clearly delineated. METHODOLOGY: We treated 5 patients for non-hepatic intraabdominal recurrence of gastric carcinoma surgically. All the resected specimens were microscopically identified as recurrent gastric cancer. Three of 5 patients received postoperative chemotherapy. The clinicopathological findings were analyzed according to the general rules for gastric cancer study. RESULTS: The lymph nodes were dissected for lymph node metastases. Surgical resection of the tumors combined with total gastrectomy, esophagectomy, or colectomy was performed for the local and peritoneal recurrences. All of the recurrent tumors were macroscopically resected with curative states. One patient died of sepsis 54 days after surgery. Three patients died of recurrent gastric cancer: 2 within 1 year of surgery and 1 after 3 years. One patient still survives disease free 3 years and 6 months after the 2nd operation. CONCLUSIONS: Surgical resection for non-hepatic intraabdominal recurrence of gastric cancer is the treatment of choice for selected patients. Surgical resection followed by adjuvant chemotherapy may improve the outcome of these patients.     

Meta-analysis of intraperitoneal chemotherapy for gastric cancer

AIM: To assess the efficacy and safety of intraperitoneal chemotherapy in patients undergoing curative resection for gastric cancer through literature review. METHODS: Medline (PubMed) (1980-2003/1), Embase (1980-2003/1), Cancerlit Database (1983-2003/1) and Chinese Biomedicine Database (1990-2003/1) were searched. Language was restricted to Chinese and English. The statistical analysis was performed by RevMan4.2 software provided by the Cochrane Collaboration. The results were expressed with odds ratio for the categorical variables. RESULTS: Eleven trials involving 1 161 cases were included. The pooled odds ratio was 0.51, with a 95% confidence interval (0.40-0.65). Intraperitoneal chemotherapy may benefit the patients after curative resection for locally advanced gastric cancer, and the combination of intraperitoneal chemotherapy with hyperthermia or activated carbon particles may provide more benefits to patients due to the enhanced antitumor activity of drugs. Sensitivity analysis and fail-safe number suggested that the result was comparatively reliable. However, of 11 trials, only 3 studies were of high quality. CONCLUSION: Intraperitoneal chemotherapy after curative resection for locally advanced gastric cancer may be beneficial to patients. Continuous multicenter, randomized, double blind, rigorously designed trials should be conducted to draw definitive conclusions.     

The role of chemotherapy in the management of gastric cancer

Despite a marked decline in the incidence of gastric carcinoma in Western countries, the majority of patients presents with advanced inoperable tumors. In this setting, usually the aim of therapy is palliation, with the exception of chemotherapy administered in the attempt to downstage the tumor and to facilitate potentially curative surgery in patients with locally advanced nonmetastatic disease. This review will focus on the use of chemotherapy for advanced gastric cancer and after curative surgery, providing an overview of future directions for clinical research: preoperative (neoadjuvant) systemic chemotherapy, intraperitoneal treatment, and newer drugs.     

Clinical significance of preoperative regional intra-arterial infusion chemotherapy for advanced gastric cancer

AIM: Preoperative intra-arterial infusion chemotherapy could increase the radical resection rate of advanced gastric cancer, but its effect on the long-term survival has not been assessed. This study was designed to evaluate the clinical significance of preoperative intra-arterial infusion chemotherapy for advanced gastric cancer. METHODS: Clinicopathological data of 91 patients who underwent curative resection for advanced gastric cancer were collected. Among them, 37 patients undertaken preoperative intra-arterial infusion chemotherapy were used as the interventional chemotherapy group, and the remaining 54 patients as the control group. Eleven factors including clinicopathological variables, treatment procedures and molecular biological makers that might contribute to the long-term survival rate were analyzed using Cox multivariate regression analysis. RESULTS: The 5-year survival rate was 52.5% and 39.8%, respectively, for the interventional group and the control group (P<0.05). Cox multivariate regression analysis revealed that the TNM stage (P<0.001), preoperative intra-arterial infusion chemotherapy (P = 0.029) and growth pattern (P = 0.042) were the independent factors for the long-term survival of patients with advanced gastric cancer. CONCLUSION: Preoperative intra-arterial infusion chemotherapy plays an important role in improving the prognosis of advanced gastric cancer.     

蒽环类药物及其新剂型在晚期胃癌化疗中的价值

胃癌治疗的关键在于早期诊断和及时行根治性切除术。我国的胃癌发病率高,且多数患者在确诊时已进入中晚期,因此以化疗为主的综合治疗是其主要治疗手段。化疗可延长晚期胃癌患者的生存期,提高生活质量。蒽环类药物参与的多种化疗方案在晚期胃癌的治疗中有一定效果。随着脂质体等新剂型研究的日益深入．有望进一步降低蒽环类药物的不良反应,提高其临床应用价值。     

Retrospective analysis of adjuvant chemotherapy for curatively resected gastric cancer

AIM:To determine the efficacy of adjuvant chemotherapy for gastric cancer in clinical practice,a retrospective analysis was conducted in a high-volume Chinese cancer center.METHODS:Between November 1995 and June 2007,a total of 423 gastric or esophagogastric adenocarcinoma patients who did(Arm A,n=300)or did not(Arm S,n=123)receive radical gastrectomy followed by postoperative chemotherapy were enrolled in this retrospective analysis.In Arm A,monotherapy(fluoropy rimidines,n=25),doublet(platinum/fluoropyrimidines,n=164),or triplet regimens[docetaxel/cisplatin/5FU(DCF),or modified DCF,epirubicin/cisplatin/5FU(ECF)or modified ECF,etoposide/cisplatin/FU,n=111]were administered.Disease-free survival(DFS)and overall survival(OS)were compared between the two arms.A subgroup analysis was carried out in Arm A.A multivariate analysis of prognostic factors was conducted.RESULTS:Stage?Ⅰ,ⅡandⅢcancers accounted for9.7%,35.7%and 54.6%of the cases,respectively,according to the American Joint Committee on Cancer(AJCC)staging system,7th edition.Only 178(42.1%)patients had more than 15 lymph nodes harvested.Hazard ratio estimates for Arm A compared with Arm S were 0.47(P<0.001)for OS and 0.59(P<0.001)for DFS.The 5-year OS rate was 52%in Arm A vs36%in Arm S(P=0.01);the adverse events in Arm A were mild and easily controlled.Ultimately,73 patients(26.5%)who received doublet or triplet regimens switched to monotherapy with fluoropyrimidines.The OS and DFS did not differ between monotherapy and the combination regimens,however,both were statistically improved in the subgroup of patients who were switched to monotherapy with fluoropyrimidines after doublet or triplet regimens as well as patients who received≥8 cycles of chemotherapy.CONCLUSION:In clinical practice,platinum/fluoropyrimidines with adequate treatment duration is recommended for stageⅡ/Ⅲgastric cancer patients accordingto the 7th edition of the AJCC staging system after curative gastrectomyeven with limited lymphadenectomy.