氟尿嘧啶与亚叶酸钠同时连续静脉滴注联合奥沙利铂治疗转移性结直肠癌的临床观察

目的 比较同时持续静脉滴注氟尿嘧啶及亚叶酸钠联合奥沙利铂方案和改良FOLFOX6方案治疗转移性结直肠癌的疗效与毒副反应，评估亚叶酸钠代替亚叶酸钙的可行性。方法 54例晚期转移性结直肠癌患者分为亚叶酸钠组（n=30）和亚叶酸钙组（n=24）。亚叶酸钠组具体方案为：奥沙利铂85mg／m²静滴d₁，氟尿嘧啶0.4g／m2静推d1，氟尿嘧啶2.4g／m²+亚叶酸钠0.4g／m2静脉持续泵入46h；亚叶酸钙组为改良FOLFOX6方案，具体为：奥沙利铂85mg／m2静滴d1，亚叶酸钙0.4g／m²静滴d₁，氟尿嘧啶0.4g／m²静推d₁，氟尿嘧啶2.4g／m²静脉持续泵入46h。均14天为1周期，4个周期后评价疗效及毒副反应。结果亚叶酸钠组获CR 3例，PR 13例，SD 10例，有效率（RR）为53.3％，疾病控制率（DCR）86.7％；亚叶酸钙组获CR 1例，PR 11例，SD 9例，RR为50.0％，DCR为87.5％，差异无统计学意义（P＞0.05）。主要毒副反应为1～2级消化道反应、骨髓抑制和脱发，两组发生率差异均无统计学意义（P＞0.05）。结论 亚叶酸钠与氟尿嘧啶同时持续静脉滴注对结直肠癌安全、有效、方便，临床上用亚叶酸钠替代亚叶酸钙是可行的。

Clinical observation of simultaneous continuous infusion of fluorouracil and disodium folinate combined with oxaliplatin for metastatic colorectal cancer

Objective To observe the efficacy and adverse effects of simultaneous continuous infusion of fluorouracil（5-FU） and disodium folinate（Na-FA） combined with oxaliplatin comparing to mFOLFOX6 regimen in metastatic colorectal cancer, and to e- valuate the feasibility of calcium folinate（Ca-FA） substituted by Na-FA. Methods A total of 54 patients with measurable metastatic colorectal cancer for whom had no previous FOLFOX treatment, were received infusion of disodium folinate and fluorouracil simultane- ously regimen（ group Na-FA,n = 30） and mFOLFOX6 regimen（ group Ca-FA, n = 24）. The regimens were taken as follow, group Na- FA： oxaliplatin 85 mg/m2 iv dI , 5-FU 0. 4 g/m： bolus dj , and 5-FU 2.4g/m2 mixed with Na-FA 0.4g/m2 infusion 46 hours. Group Ca-FA： oxaliplatin 85mg/m2 iv dI , Ca-FA 0.4g/m2 iv dI , 5-FU 0.4g/m2 bolus dl , and 5-FU 2.4g/m2 infusion 46 hours. Fourteen days was a cycle for both 2 groups. The short term effects and safety of the two groups were evaluated according to the RECIST entity tumors evaluation criteria and anticancer drugs common toxicity grading criteria after 4 cycles. Results There were 3 CR, 13 PR and 10 SD in group Na-FA, and the response rate and disease control rate were 53.3% and 86. 7% ; there were 1 CR, 11 PR and 9 SD in group Ca-FA, and the response rate and disease control rate were 50. 0% and 87.5%. There was no signifcant difference in the two groups. The common side effects were grade 1-2 gastric reactions, grade 1-2 myelosuppression and grade 1-2 hair loss. The incidence rates of side effects were no statistical difference between the two groups. Conclusion Continuous infusion of disodium folinate and 5- FU simultaneously for patients with colorectal cancer is safe, effective and convenient. As the result, calcium folinate can be substitu- ted by disodium folinate in mFOLFOX regimen.