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背景与目的:手术治疗目前仍是无远处转移胃癌的标准治疗方法,但大多数胃癌患者就诊时已经是进展期而不宜手术。新辅助化疗是指在外科手术术前给予化疗,其目的之一是通过缩小原发肿瘤使之可以进行手术切除,最终延长生存期。本临床试验目的在于研究多西他赛(商品名:泰索帝)联合顺铂、氟尿嘧啶和亚叶酸给药方案术前进行诱导化疗对不能切除的进展期胃癌的临床疗效及毒副反应。方法:入组患者均为本院2003年6月—2005年6月收治的12例晚期胃癌而无法行根治手术者。术前的新辅助化疗方案为:泰索帝75 mg/m2、顺铂75 mg/m2第1天;氟尿嘧啶500 mg/m2、亚叶酸200 mg/m2第1~5天,每三周为一个周期,共两个周期。观察新辅助化疗后原发病灶的变化情况并观察用药后的毒副反应。结果:新辅助化疗后9例患者获得肿瘤减期,疗程结束后4~6周8例进行根治性手术切除。临床完全缓解(CR)1例,部分缓解(PR)8例,无变化(NC)3例,进展(PD)0例,有效率75%(9/12),腹水消退率63.6%(7/11)。组织学效果:轻度有效3例,中度有效4例,显著有效1例。副反应主要为骨髓抑制、腹泻、恶心呕吐、脱发,经对症以及营养支持治疗后均能缓解。结论:多西他赛加顺铂、氟尿嘧啶及亚叶酸的新辅助化疗方案在高度进展期胃癌的治疗中,对提高手术切除率疗效显著,耐受性良好。
BACKGROUND & OBJECTIVE: Surgical treatment is still the standard treatment for metastatic gastric cancer without distant metastasis. However, most patients with gastric cancer are already in advanced stage of treatment and should not be surgically treated. Neoadjuvant chemotherapy is given before surgery to give chemotherapy, one of the purposes is to reduce the primary tumor so that it can be surgically removed, and ultimately prolong survival. The purpose of this clinical trial is to study the clinical efficacy and side effects of docetaxel (trade name: taxotere) in combination with cisplatin, fluorouracil and leucovorin regimens for the induction of chemotherapy for unresectable advanced gastric cancer. Methods: All patients were admitted to our hospital from June 2003 to June 2005 admitted to 12 cases of advanced gastric cancer and can not be radical surgery. Preoperative neoadjuvant chemotherapy regimen: Taxotere 75 mg / m2, cisplatin 75 mg / m2 on day 1; fluorouracil 500 mg / m2, leucovorin 200 mg / m2 on days 1 to 5 every three weeks Period, a total of two cycles. Observe the changes of primary lesion after neoadjuvant chemotherapy and observe the side effects after treatment. Results: Nine patients after neoadjuvant chemotherapy achieved tumor reduction. Eight patients underwent radical resection 4 to 6 weeks after the end of treatment. 1 patient had complete remission (CR), 8 had partial remission (PR), 3 had no change (NC), 0 had PD. The effective rate was 75% (9/12), the rate of ascites regression was 63.6% 11). Histological effect: mild effective in 3 cases, moderate effective in 4 cases, significantly effective in 1 case. Side effects are mainly myelosuppression, diarrhea, nausea, vomiting, hair loss, symptomatic and nutritional support after treatment can be alleviated. CONCLUSIONS: The neoadjuvant chemotherapy regimen of docetaxel plus cisplatin, fluorouracil and leucovorin has been shown to be effective and effective in improving the resection rate in the treatment of advanced gastric cancer.