Safran H, Wanebo H J, Hesketh P J, Akerman P, Ianitti D, Cioffi W, DiPetrillo T, Wolf B, Koness J, McAnaw R, Moore T, Chen M H, Radie-Keane K
The Brown University Oncology Group, Providence, RI 02906, USA.
Int J Radiat Oncol Biol Phys. 2000 Mar 1;46(4):889-94. doi: 10.1016/s0360-3016(99)00436-8.
To determine the activity and toxicity of paclitaxel and concurrent radiation for gastric cancer.
Twenty-seven patients were studied. Twenty-five had proximal gastric cancers, two had distal cancers. Eight had esophageal extension, 6 had celiac adenopathy, and 7 had retroperitoneal adenopathy. Patients received paclitaxel, 50 mg/m(2) by 3-hour intravenous (IV) infusion, weekly, on days 1, 8, 15, 22, and 29. Radiation was administered concurrently to a total dose of 45.0 Gy, in 1.80 Gy fractions, for 25 treatments. Patients who were medically or surgically inoperable received a sixth week of paclitaxel with a radiation boost to 50.4 Gy.
Esophagitis and gastritis were the most important toxicities, Grade 3 in four patients (15%), and Grade 4 in three patients (11%). Five patients (19%) had Grade 3 nausea. The overall response rate was 56%, including three patients (11%) with a complete response. The 2-year progression-free and overall survival rates were 29% and 31%, respectively.
Concurrent paclitaxel and radiation demonstrates substantial local-regional activity in gastric cancer. Future investigations combining paclitaxel and radiation with other local-regional and systemic treatments are warranted.
确定紫杉醇与同步放疗治疗胃癌的活性和毒性。
对27例患者进行了研究。25例为近端胃癌，2例为远端胃癌。8例有食管侵犯，6例有腹腔淋巴结肿大，7例有腹膜后淋巴结肿大。患者接受紫杉醇，50mg/m²，通过3小时静脉输注，每周一次，在第1、8、15、22和29天给药。同步进行放疗，总剂量为45.0Gy，每次1.80Gy，共25次治疗。因医学或手术原因无法手术的患者在第六周接受紫杉醇治疗，并将放疗剂量增加至50.4Gy。
食管炎和胃炎是最重要的毒性反应，4例患者（15%）为3级，3例患者（11%）为4级。5例患者（19%）有3级恶心。总体缓解率为56%，包括3例患者（11%）完全缓解。2年无进展生存率和总生存率分别为29%和31%。
紫杉醇与放疗同步应用在胃癌中显示出显著的局部区域活性。有必要开展将紫杉醇和放疗与其他局部区域和全身治疗相结合的进一步研究。
