草酸铂及羟基喜树碱联合亚叶酸钙和氟尿嘧啶治疗进展期结直肠癌的比较

目的比较草酸铂及羟基喜树碱联合亚叶酸钙和氟尿嘧啶(5-FU)辅助化疗方案治疗进展期结直肠癌的疗效和不良反应。方法选择某院自2009年12月～2010年5月经病理证实的进展期结直肠癌患者98例,其中49例(OH组)采用草酸铂130mg/m2联合羟基喜树碱6.0mg/m2,5-FU1000(mg/m2.d)持续静脉泵入1～2d,亚叶酸钙200mg/(m2.d),连续化疗92个周期;49例(HLF组)采用羟基喜树碱6mg/m2+生理盐水250ml,5-FU1000(mg/m2.d)持续静脉泵入1～2d,亚叶酸钙200mg/(m2.d),连续化疗43个周期,2～3周期后对两组的疗效进行评价,同时观察两组的不良反应。结果 OH组、HLF组患者的近期有效率分别为34.69%(17/49)、28.57%(14/49),两组比较疗效差异无统计学意义(P﹥0.05);两组KPS改善情况比较差异无统计学意义(P﹥0.05)。不良反应主要为感觉神经末梢毒性、骨髓抑制、呕吐、腹泻等,两组间Ⅲ、Ⅳ度不良反应以血液学毒性和胃肠道反应为主,其中腹泻发生率HLF组高于OH组,比较差异有统计学意义(P﹤0.05)。结论草酸铂及羟基喜树碱联合亚叶酸钙和氟尿嘧啶治疗进展期结直肠癌,两组的疗效相似,草酸铂外周神经末梢毒性较为常见,羟基喜树碱的腹泻不良反应较为常见。

Clinical study on the combined chemotherapy of oxaliplatinor hydroxycamptothecine plus 5-fluorouracil and leucovorin in treatment of advanced colorectal cancer

OBJECTIVE To evaluate the short-time efficacy, side effects and survival of combined chemotherapy of oxaliplatin or hydroxycamptothecine plus 5-fluorouracil and leucovorin in treatment of progressing carcinoma of rectum. METHODS From December 2009 to May 2011, 98 cases with advanced colorectal cancer were pathologically confirmed and included in this study. The patients in OH (n = 49) received oxaliplatin plus 5-fluorouracil and leucovorin, and those in HLF group (n = 49) were treated with hydroxycamptothecine plus 5-fluorouracil and leucovorin. Both regimens had 92 months cycle, the treatment was repeated 43 months and the side effects were evaluated. The efficacy was estimated after chemotherapy. RESULTS OH group and HLF group of patients with recent rates were 34.69% (17 / 49) and 28.57% (14 / 49), respectively. There was no significant difference in efficacy between the two groups (P﹥0.05); The median progression-free survival (mPFS), median overall survival (mOS) and 1-year survival rate did not show significant difference between the two groups (P﹥0.05). The major toxic reactions were sensory nerve endings toxicity, bone marrow suppression, vomiting and diarrheam etc. The main adverse reactions for Ⅲ and Ⅳ of the two groups degree were bone marrow suppression and gastrointestinal reactions. The incidence of diarrhea HLF group was significantly higher than that of OH group, and there was no significantly difference (P﹤ 0.05). CONCLUSION The efficacy is almost equal between combined chemotherapy of oxaliplatin or hydroxycamptothecine plus 5-fluorouracil and leucovorin for advanced colorectal cancer. The efficacy of the two groups were similar, and the main adverse effect was peripheral neuropathy, while diarrhea is a common adverse effect.