Chao Y, Teng H C, Hung H C, King K L, Li C P, Chi K H, Yen S H, Chang F Y
Division of Gastroenterology, Veterans General Hospital, Taipei, Taiwan.
Jpn J Clin Oncol. 2000 Mar;30(3):122-5. doi: 10.1093/jjco/hyd038.
Acute disseminated intravascular coagulation (DIC) is a rare but severe complication of gastric adenocarcinoma. Conventional treatments, such as fresh frozen plasma, platelet replacement and heparin injections, are disappointing. The only way to correct this fatal condition is to control the underlying cancer promptly by effective chemotherapy. Here the successful initial control of acute DIC in gastric cancer patients with weekly EEPFL chemotherapy is reported.
Advanced gastric cancer patients complicated with acute DIC were eligible. Patients were treated with weekly EEPFL therapy (etoposide 40, epirubicin 10, cisplatin 25, 5-fluorouracil 2200 and leucovorin 120 mg/m2 ). Response, survival and toxicity were evaluated.
From April 1997 to April 1999, six patients were included in this study. All patients received EEPFL chemotherapy. Clinical and laboratory evidence of acute DIC stabilized quickly after starting chemotherapy. Four patients showed a partial response, one stable disease and one progressive disease. The toxicity was mild and well tolerated. Median survival was 28 weeks (12, 14, 26, 30, 30 and 32 weeks). All patients suffered from a relapse of DIC after initial successful control and died within 30 days of clinical and laboratory evidence of acute DIC relapse.
EEPFL therapy is an effective chemotherapy regimen for patients with advanced gastric cancer associated with acute DIC. The prognosis is poor if the DIC relapses after the initial successful control.
急性弥散性血管内凝血（DIC）是胃腺癌一种罕见但严重的并发症。传统治疗方法，如输注新鲜冷冻血浆、补充血小板和注射肝素，效果不佳。纠正这种致命状况的唯一方法是通过有效的化疗迅速控制潜在的癌症。本文报道了采用每周EEPFL化疗成功初步控制胃癌患者急性DIC的情况。
入选患有急性DIC的晚期胃癌患者。患者接受每周一次的EEPFL治疗（依托泊苷40、表柔比星10、顺铂25、5-氟尿嘧啶2200和亚叶酸钙120mg/m²）。评估疗效、生存率和毒性。
1997年4月至1999年4月，本研究纳入6例患者。所有患者均接受EEPFL化疗。开始化疗后，急性DIC的临床和实验室证据迅速稳定。4例患者部分缓解，1例病情稳定，1例病情进展。毒性轻微且耐受性良好。中位生存期为28周（12、14、26、30、30和32周）。所有患者在最初成功控制后均出现DIC复发，并在急性DIC复发的临床和实验室证据出现后30天内死亡。
EEPFL治疗是治疗伴有急性DIC的晚期胃癌患者的有效化疗方案。如果DIC在最初成功控制后复发，预后较差。
