静脉和腹腔化疗联合热疗治疗晚期胃癌伴腹水的疗效观察

目的观察多西他赛+氟尿嘧啶(5-Fu)静脉滴注全身化疗和腹腔内灌注顺铂局部化疗及热疗治疗晚期胃癌伴腹水的疗效及不良反应。方法 56例晚期胃癌合并癌性腹水患者采用联合静脉滴注多西他赛+持续静脉滴注5-Fu全身化疗和腹腔内灌注顺铂局部化疗并予局部热疗方案治疗;治疗2⁶个周期,每2个周期后评价疗效、临床受益及不良反应。结果 56例均可评价疗效,其中完全缓解(CR)12例(21.4%),部分缓解(PR)23例(41.1%),总有效率(RR)为62.5%,肿瘤进展时间(TTP)为8.7个月,中位生存期(OS)为13.4个月。腹水CR 15例(26.7%),PR 28例(50.0%),RR为76.7%。主要不良反应为骨髓抑制、消化道反应和口腔黏膜炎,其中Ⅲ6个周期,每2个周期后评价疗效、临床受益及不良反应。结果 56例均可评价疗效,其中完全缓解(CR)12例(21.4%),部分缓解(PR)23例(41.1%),总有效率(RR)为62.5%,肿瘤进展时间(TTP)为8.7个月,中位生存期(OS)为13.4个月。腹水CR 15例(26.7%),PR 28例(50.0%),RR为76.7%。主要不良反应为骨髓抑制、消化道反应和口腔黏膜炎,其中Ⅲ^Ⅳ度白细胞及血小板下降率为19.6%,ⅢⅣ度白细胞及血小板下降率为19.6%,Ⅲ^Ⅳ度血小板下降率为7.1%,ⅠⅣ度血小板下降率为7.1%,Ⅰ^Ⅱ度恶心呕吐、腹泻腹痛的发生率为58.9%,ⅢⅡ度恶心呕吐、腹泻腹痛的发生率为58.9%,Ⅲ^Ⅳ度为5.4%。无治疗相关性死亡。结论静脉化疗(多西他赛+5-Fu)和腹腔化疗(顺铂)的改良DCF方案及热疗是治疗晚期胃癌伴腹水的有效手段,不良反应可以耐受,值得临床进一步研究。

Clinical study of intravenous chemotherapy and intraperitoneal chemotherapy combined with thermal therapy in treating patients with advanced gastric cancer with malignant ascites.

Objective To evaluate the clinical efficiency and toxicity of intravenous chemotherapy combined with intraperitoneal chemotherapy and thermal therapy in treating advanced gastric cancer patients with malignant ascites. Methods Fifty-six patients with advanced gastric caner with malignant ascites received a combination chemotherapy that used intravenous chemotherapy of docetaxol 75 mg/m2 IV drip dl and 5-Fu 2. 5 g/m2CIV drip for 120 h, intraperitoneal chemotherapy （ DDP 40 mg/m2dl, d8 ） and thermal therapy,repeated every 3 weekso Results Among 56 patients, complete response 12 case, partial response 23 cases, in which the total response rate was 62. 5%. Median time to progression was 8.7 months, median survival time was 13.4 months. The main toxicities included myelosuppression, gastrointestinal reaction and mucositis. Conclusion Intravenous chemotherapy combined with intraperitoneal chemotherapy and thermal therapy were effective in treating patients with advanced gastric cancer with malignant ascitesr, the toxicity is mild and tolerable for most patients.