奥沙利铂累积剂量与蓄积性神经毒性的相关分析

目的　观察奥沙利铂联合氟尿嘧啶和亚叶酸钙（ＦＯＬＦＯＸ４）方案治疗胃肠道恶性肿瘤的不良反应，探讨奥沙利铂神经毒性反应的发生与累积剂量的关系。方法　１１４例胃肠道恶性肿瘤患者应用ＦＯＬＦＯＸ４方案治疗，具体为：奥沙利铂８５ｍｇ／ｍ^２，静滴２ｈ，ｄ_１；亚叶酸钙２００ｍｇ／ｍ^２，静滴２ｈ，注射后立即静脉推注氟尿嘧啶４００ｍｇ／ｍ^２，后予氟尿嘧啶６００ｍｇ／ｍ^２，持续静滴２２ｈ，ｄ_１、ｄ_２，２周为１周期。挽救化疗患者每２个周期评价疗效，至疾病进展。辅助化疗持续６个月，观察不良反应。结果　１１４例患者的神经毒性反应、恶心呕吐及白细胞减少发生率较高，但均较轻微，３～４级不良反应较为少见，其中恶心呕吐发生率为７.９％，白细胞减少１４.０％，血小板减少３.５％以及腹泻３.５％。奥沙利铂累积剂量在１５０～４２０ｍｇ／ｍ^２、４５０～８００ｍｇ／ｍ^２和８２０～９９６ｍｇ／ｍ^２时，神经毒性反应的发生率分别为４３.８％、８９.７％和１００.０％，５例累积剂量≥１００８ｍｇ／ｍ^２患者中有３例出现３级神经毒性反应。结论　ＦＯＬＦＯＸ４方案化疗的不良反应较轻，其中奥沙利铂神经毒性的发生率及严重程度与其累积剂量呈正相关。

Analysis of the correlation between the neurotoxicity and the cumulative dose of oxaliplatin

Objective To analyze the side effects of oxaliplatin in combination with leucovorin and fluorouracil(FOLFOX 4) in the treatment of gastrointestinal carcinoma,and the relationship between the occurrence of neurotoxicity of oxaliplatin and the cumulative dose.Methods One hundred and fourteen patients were taken FOLFOX 4 regimen:oxaliplatin 85mg/m2,intravenous infusion 2h,d1;leucovorin 200mg/m2,intravenous infusion 2h,then following fluorouracil 400mg/m2,intravenous injection,follow-fluorouracil 600mg/m2,iv co...