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目的:探讨多西紫杉醇、奥沙利铂、希罗达(DOX)方案新辅助化疗在进展期胃癌治疗中的作用。方法:收集2008年10月~2011年3月本院确诊进展期胃癌的患者58例纳入化疗组,术前行DOX方案2周期,于化疗后14~21 d期间行手术治疗。同期收治的未经新辅助化疗的进展期胃癌58例作为对照,对照组确诊后2周内手术,术后根据胃癌的规范治疗原则行辅助化疗。结果:化疗组患者均完成术前新辅助化疗,化疗后评估:完全缓解(CR)5例,部分缓解(PR)32例,疾病稳定(SD)20例,疾病进展(PD)l例,总有效率为63.8%。R0切除率明显高于对照组(87.9%vs 63.8%,P<0.05),其中食管胃交界癌(EGC)CR 3例,PR 12例较远端胃癌CR 2例,PR 20例效果更加显著(P<0.05)。主要不良反应为粒细胞减少、胃肠道不良反应、外周神经毒性等;术后并发症发生率差异无统计学意义(3.4%vs 1.7%,P>0.05),两组1年生存率均为100%,化疗组2年生存率明显高于对照组(75.8%vs 55.1%,P<0.05)。结论:DOX方案新辅助化疗治疗进展期胃癌,尤其是食管胃交界癌,有效率高,患者耐受性及依从性好,可缩小瘤体,降低分期,提高R0切除率,提高生存率。
Objective: To investigate the effect of neoadjuvant chemotherapy with docetaxel, oxaliplatin, and doxorubicin (DOX) in the treatment of advanced gastric cancer. Methods: Fifty-eight patients with diagnosed advanced gastric cancer in our hospital from October 2008 to March 2011 were enrolled in the chemotherapy group. DOX 2 cycles were performed preoperatively and 14 to 21 days after chemotherapy. In the same period, 58 cases of advanced gastric cancer without neoadjuvant chemotherapy were taken as the control group. The control group was operated within 2 weeks after diagnosis, and adjuvant chemotherapy was performed according to the standard treatment principle of gastric cancer after operation. Results: The patients in the chemotherapy group had completed the preoperative neoadjuvant chemotherapy. After the chemotherapy, 5 patients had complete remission (CR), 32 patients had partial remission (PR), 20 patients had stable disease (SD), 1 patient had progressive disease (PD) The effective rate is 63.8%. R0 resection rate was significantly higher than that of the control group (87.9% vs 63.8%, P <0.05). Among them, 3 cases of esophageal-gastric cancer (EGC) CR and 12 cases of PR were more effective than 2 cases of distal gastric cancer CR and 20 cases of PR 20 P <0.05). The main adverse reactions were neutropenia, gastrointestinal adverse reactions, peripheral neurotoxicity and so on. The incidence of postoperative complications was not significantly different (3.4% vs 1.7%, P> 0.05). The 1-year survival rates were 100%. The 2-year survival rate of the chemotherapy group was significantly higher than that of the control group (75.8% vs 55.1%, P <0.05). CONCLUSION: DOX regimen neoadjuvant chemotherapy is effective in advanced gastric cancer, especially in esophageal and gastric cancer. It has high efficiency, good patient tolerance and good compliance. It can reduce tumor, reduce staging, improve R0 resection rate and improve survival rate.