改良DCF方案与XELOX方案一线治疗晚期胃癌的临床观察

目的:观察改良DCF方案与XELOX方案一线治疗晚期胃癌的临床疗效和安全性。方法:收集2010年10至2013年7月收治的65例初治晚期胃癌患者，其中41例应用改良DCF方案和24例应用XELOX方案。改良DCF方案为多西他赛60mg/m2静滴，d1；顺铂15mg/m2 静滴，d1～5；氟尿嘧啶375mg/m2静滴，d1～5,21天为1周期。XELOX方案为奥沙利铂130mg/m2静滴，d1；卡培他滨 1250mg/m2,分2次口服，d1～14,21天为1周期。化疗2个周期后按照RECIST 1.1标准评价疗效，按NCI CTC 3.0版评价毒副反应并随访生存情况。结果:65例患者均可评价疗效。改良DCF方案和XELOX方案的有效率（RR）分别为34.1%和33.3%，疾病控制率（DCR）分别为75.6%和70.8%，中位无进展生存期（PFS）分别为7.6个月和7.2个月，中位生存时间（OS）分别为11.9个月和11.5个月，以上差异均无统计学意义（P＞0.05）。两组不良反应均可耐受，主要表现为骨髓抑制、乏力、消化道反应，以I-II级为主，III-IV级较少；但DCF组白细胞下降和乏力发生率高于XELOX组(P＜0.05），XELOX组周围神经毒性和手足综合征发生率高于DCF组(P＜0.05）。结论:改良DCF方案与XELOX方案一线治疗晚期胃癌的疗效相近，毒副反应可耐受，临床上可根据患者年龄、体力状况及其他因素个体化选择化疗方案。

Clinical observation of modified DCF regimen versus XELOX regimen as first -line treat-ment for advanced gastric cancer

Objective:To evaluate the efficacy and toxicity of modified DCF regimen compared with XELOX regimen as the first-line treatment for patients with advanced gastric cancer.Methods:Form October 2010 to July 2013,Sixty-five advanced gastric cancer patients without chemotherapy as initial treatment were enrolled.Forty-one patients received modification DCF regimen(docetaxel 60mg/m2 iv,d1；cisplatin 15mg/m2 iv d1~5；flurouracil 375mg/m2 iv d1~5；21 days was a cycle).Twenty-four patients received XELOX regimen(oxaliplatin 130mg/m2 iv,d1；capecitabine 1250mg/m2 po bid,d1~14.21 days was a cycle).The efficacy and the toxicity were evaluated according to RECIST 1.1 criteria and the NCI CTC 3.0 every 2 cycles.The survival status were followed up.Results:Efficacy could be evaluated in all patients.The response rates(RR) were 34.1% and 33.3%,and the disease control rates(DCR) were 75.6% and 70.8% in modified DCF regimen and XELOX regimen group,respectively.The median progression-free survival(PFS) and overall survival(OS) were 7.6 months and 11.9 months in modified DCF regimen group and 7.2 months and 11.5 months in XELOX regimen group with no significant differences （P＞0.05）.Toxicity of two groups were tolerable.The main toxicities were myelosuppression,fatigue and digestive tract reaction,mainly in grade I-II,and rarely in grade III-IV.The incidence of myelosuppression and fatigue were higher in DCF regimen group than those in XELOX regimen group with significant differences(P＜0.05）.The incidence of peripheral neuropathy and hand-foot syndrome lower in DCF regimen group than those in XELOX regimen group with significant differences(P＜0.05）.Conclusion:There are similar efficacy and toxicities between modified DCF regimen and XELOX regimen as the first-line chemotherapy for patients of advanced gastric cancer.We should choose individual chemotherapy regimens by patients' age，performance status and other factors．