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目的探讨多西紫杉醇联合5-氟尿嘧啶(5-FU)及顺铂治疗进展期胃癌的临床疗效。方法多西紫杉醇45mg/m2以生理盐水或5%葡萄糖液250ml稀释,于第1、8天静脉滴注lh;顺铂20mg/m2,于第1～5天静脉滴注;5-FU375mg/m2,于第1～5天持续静脉泵入(Graseby泵)。所有患者在应用多西紫杉醇前1d静脉注射地塞米松10mg,连用3d,于化疗前30min及化疗后4h常规应用5-羟色胺受体拮抗剂止吐。28d为1个治疗周期,至少2个周期后评价疗效及不良反应。结果初治组38例患者治疗后CR2例,PR19例,SD13例,PD4例,近期有效率55.3%;复治组17例患者治疗后CR0例,PR7例,SD6例,PD4例,近期有效率41.2%。本组总有效率50.9%。主要不良反应包括骨髓抑制、胃肠道反应、脱发等。骨髓抑制以白细胞下降最为明显,Ⅲ～Ⅳ度占21.8%(12/55),高峰期在化疗后7～15d,多在第4周左右恢复,予以粒细胞集落刺激因子(G-CSF)后均能按时完成化疗周期。胃肠道反应主要表现为恶心、呕吐、腹泻和口腔黏膜炎等,多为I～Ⅱ度。脱发也见于大部分患者,多为I～Ⅱ度。未出现严重的肝肾功能损害、过敏反应和心脏损害,无化疗相关死亡病例。结论多西紫杉醇联合5-FU及顺铂的化疗方案疗效确切,毒副作用可以为患者所耐受,对于延长进展期胃癌患者的生存期具有一定作用。
Objective To investigate the clinical efficacy of docetaxel combined with 5-fluorouracil (5-FU) and cisplatin in the treatment of advanced gastric cancer. Methods Docetaxel 45mg / m2 diluted with normal saline or 5% dextrose 250ml, on the first and eighth day intravenous drip lh; cisplatin 20mg / m2, on the first 5 days intravenous drip; 5-FU375mg / m2 , On the 1st to 5 days continuous intravenous (Graseby pump). All patients were given intravenous injection of dexamethasone 10 mg 1 d before application of docetaxel, even for 3d, 30 min before chemotherapy and 4 h after chemotherapy. Serotonin receptor antagonists were conventionally used to stop vomiting. 28d for a treatment cycle, at least 2 cycles after the evaluation of efficacy and adverse reactions. Results Among the 38 patients in the initial treatment group, CR2, PR19, SD13, and PD were effective in the short-term after treatment, and the effective rate was 55.3% in the early treatment group. CR0, PR7, SD6 and PD4 41.2%. The total effective rate of 50.9%. The main adverse reactions include myelosuppression, gastrointestinal reactions, hair loss and so on. Myelosuppression in the most obvious leukopenia, Ⅲ ~ Ⅳ degrees accounted for 21.8% (12/55), the peak of 7 to 15 days after chemotherapy, mostly in the first 4 weeks recovery, to be granulocyte colony stimulating factor (G-CSF) after Chemotherapy cycle can be completed on time. Gastrointestinal reactions mainly for nausea, vomiting, diarrhea and oral mucositis, mostly for I ~ II degrees. Hair loss is also seen in most patients, mostly I ~ II degrees. No serious liver and kidney dysfunction, allergic reaction and heart damage, no chemotherapy-related deaths. Conclusion Docetaxel combined with 5-fluorouracil and cisplatin chemotherapy regimen has definite curative effect, and its toxic side effects can be tolerated by patients and plays a role in prolonging the survival of patients with advanced gastric cancer.