两种解救方案用于晚期胃癌一线化疗失败后的疗效比较.doc

两种解救方案用于晚期胃癌一线化疗失败后的疗效比较 　　作者：王莉莉,崔洁,柯红　　作者单位：葛洲坝中心医院，三峡大学第三临床医学院，湖北 宜昌 443002 　　【摘要】目的：回顾性分析两种不同化疗方案对一线化疗失败的晚期胃癌患者进行解救治疗的疗效和安全性，探讨晚期胃癌二线治疗适宜的化疗方案。方法：43 例一线化疗失败的晚期胃癌患者，分为多西他赛组19 例，多西他赛联合氟尿嘧啶(5-Fu)及亚叶酸钙(LV)和奥沙利铂组24 例(奥沙利铂联合5-Fu及LV)。43 例均可评价不良反应，40 例可评价客观疗效。结果：多西他赛组和奥沙利铂组的总有效率(RR)分别为11.1%和13.6%，差异无统计学意义(P0.05);疾病控制率(DCR)分别为44.4%和54.5%(P0.05);两组疾病进展时间(TTP)分别为(3.02±0.45)个月和(3.19±0.60)个月(P0.05)。两组生存期(OS)分别为(6.09±1.29)个月和(6.71±1.29)个月(P0.05)。两组不良反应均易耐受，主要为Ⅰ～Ⅱ级血液学毒性、消化道反应;奥沙利铂组外周神经毒性为37.5%，与多西他赛组比较差异有统计学意义(P0.01)。结论：晚期胃癌一线治疗失败后采用多西他赛联合5-Fu及LV或奥沙利铂联合5-Fu及LV解救治疗有一定的临床疗效，且不良反应可耐受，但尚需进一步探索更有效的治疗方案。 　　【关键词】 晚期胃癌;化学治疗;二线;多西他赛;奥沙利铂 　　Abstract Objective：To retrospectively analyse the efficacy and safty of two different rescue chemotherapies after failure of first-line chemotherapy in patients with advanced gastric cancer，to investigate the appropriate programs for second-line chemotherapy.Methods：Forty-three patients progressive to first-line chemotherapy were allocated to the groups of docetaxel therapy[docetaxel plus 5-fluorouracil(5-Fu) and leucovorin，19 cases]or oxaliplatin treatment (oxaliplatin plus 5-Fu and leucovorin(LV)，24 cases).Results：Forty-three patients were evaluated adverse event，and 40 patients were evaluated efficacy.The response rate (RR) were 11.1%，13.6%(P0.05)，the disease control rate (DCR) were 44.4%，54.5%(P0.05) in docetaxel-group and oxaliplatin-group respectively.Time to progression (TTP) were (3.02±0.45) months，(3.19±0.60) months，overall survival (OS) (6.09±1.29) months，(6.71±1.29) months in docetaxel-group and oxaliplatin-group，respectively，showing no significant difference(P0.05).Toxicity was tolerable，major adverse event were grade Ⅰ and Ⅱ hematologic toxcity and gastrointestinal reactions in two groups.The peripheral nerve toxicity (37.5%) in oxaliplatin-group was higher than docetaxel-group.Great sighificances were found between them(P0.05).Conclusion：Commonly used docetaxel joint treatment of 5-Fu and LV or oxaliplatin combined with 5-F