晚期胃癌非根治性术后腹腔联合静脉化疗与单纯静脉化疗的临床观察

目的: 探讨晚期胃癌非根治性术后腹腔热灌注化疗联合FOLFOX4方案静脉化疗的临床疗效及毒副反应。 方法: 选取青岛市肿瘤医院2002年1月至2005年2月65例晚期胃癌姑息性切除术后患者随机分为两组,治疗组采用术后腹腔热灌注化疗顺铂(DDP)60～80mg/m²、丝裂霉素(MMC)4～6mg/m²、5-氟脲嘧啶(5-FU)75mg/m²,2周为1个周期并联合FOLFOX4(L-OHP85mg/m²静脉滴注2h,d₁;LV200mg/m²静脉滴注2h,d₁～2;5-FU400mg/m²,LV滴完10～20min静脉推注d_1～2;5-FU600mg/m²推注后22h,civ,d_1～2,2周为1个周期)方案静脉化疗,对照组术后采用单一DF(5-FU500mg/m²d_1～3、LV200mg/m²d_1～3、DDP30～40mg/m²d_1～3,或将5-FU2.4mg/m²经携式微量输注泵在48h内连续注入,每3～4周为1个周期)方案静脉化疗,对65例患者的临床资料作回顾性分析。 结果: 治疗组1、2、3年生存率分别为83.3%(28/34)、58.8%(20/34)、44.2%(14/34),对照组为83.9%(26/31)、29.0%(9/31)、16.1%(5/31),两组1年生存率比较无显著性差异(P>0.05),2、3年生存率比较有显著性差异(P<0.05);两组化疗毒副反应比较除外周神经损害外无显著性差异。治疗组腹腔化疗并发症主要为腹痛、腹胀、腹泻、便秘。 结论: 晚期胃癌姑息性切除术后腹腔热灌注化疗联合FOLFOX4静脉化疗在晚期胃癌的综合治疗中是一种有效的治疗措施。

Clinical Observation of Intraperitoneal Hyperthermic Chemotherapy Combined with FOLFOX4 and Venous Chemotherapy after Palliative Surgery for Advanced Gastric Carcinoma

Objective : To evaluate the curative effect and the toxicities of intraperitoneal hyperthermic chemotherapycombined with FOLFOX4 and venous chemotherapy for advanced gastric carcinoma after non-radicalsurgery. Methods : A total of 65 patients with advanced gastric cancer who underwent non-radical surgery fromJanuary 2002 to February 2005 were randomly classified into two groups. Group 1 patients were treated withboth intraperitoneal chemotherapy (DDP 60~80mg/m², MMC 4~6mg/m², and 5-Fu 0.75/m², every two weeks)and intravenous chemotherapy (FOLFOX4). Patients in Group 2 received only intravenous chemotherapy ofDF (5-Fu 0.5/m²d1~3, LV 0.1/m²d1~3, DDP 30~40mg/m 2 d1~3, or 5-Fu 3.0 i.v. drip by infusion pump in 48hours, every 3-4 weeks). Results : The 1-, 2-, and 3-year survival rates were 83.3% (28/34), 58.8% (20/34),and 44.1% (14/34) in Group 1, and 83.9% (26/31), 29.0% (9/31), and 16.1% (5/31) in Group 2. There was noremarkable difference in the 1-year survival rate between the two groups (P>0.05). Significant differenceswere found in the 2- and 3-year survival rates between the two groups (P<0.05). No statistical significancewas found in the toxic reactions between the two groups (P<0.05). The complications in the two groups includ-ed abdominal discomfort, abdominal distension, diarrhea and constipation. Conclusion : Intraperitonealchemotherapy combined with intravenous FOLFOX4 chemotherapy is an advisable treatment for patients withadvanced gastric cancer who have undergone non-radical surgery.