Yabusaki Hiroshi, Nashimoto Atsushi, Tanaka Otsuo
Division of Surgery, Niigata Cancer Center Hospital.
Gan To Kagaku Ryoho. 2003 Nov;30(12):1933-40.
We performed a critical evaluation of neoadjuvant chemotherapy (NAC) with TS-1 and cisplatin (CDDP) for advanced gastric cancer patients. Since October 2000, 37 patients with far advanced or non-curative resectable gastric cancer received NAC, together with TS-1 and CDDP after informed consent was obtained. TS-1 (80 mg/m2/day) was administrated for 21 consecutive days followed by 14 days rest as one course, and CDDP (50 mg/m2) was infused over 2 hours on day 8. After at least 2 courses of treatment, the patients underwent gastrectomy with lymphadenectomy. The median number of courses administered was 3 (range 2-7), and 6 cases were treated on an outpatient basis only. The overall response rate was 62.2% (no CR, but 23 PR), and the individual response rates were 67.6% for the primary lesion, 90.5% for lymph node metastasis including para-aortic region, 50.0% for liver metastasis and 14.3% for peritoneal dissemination, respectively. Toxicities were generally mild, no treatment-related death and no serious adverse reactions were observed. There were only 2 grade 4 anemia (5.4%), and leucopenia, neutropenia, anemia, thrombocytopenia of grade 3 were observed in one (2.7%), 3 (8.1%), 6 (16.2%), and 2 (5.4%) patients respectively at hematological toxicity. Appetite loss and diarrhea of grade 3 were observed in only one (2.7%) patient at nonhematological toxicity. Twenty-four cases had undergone surgical treatment, and resection was performed in all cases. Seventeen of the 24 (70.8%) patients underwent curative resection. There was no major morbidity following surgery. The patients were favorable both for operation time (229 min) and bleeding volume (365 ml). The mean duration of hospitalization after surgery was 23.5 days and the only complications were one leakage, ileus and 2 pancreatitis. Two-year survival rate was 46.8% and MST was 523 days. In conclusion, a combination of TS-1 and CDDP for NAC appears to be an effective treatment modality for far advanced gastric cancer patients in view of toxicities, antitumor effects and QOL of the patients.
我们对晚期胃癌患者采用替吉奥（TS-1）和顺铂（CDDP）进行新辅助化疗（NAC）展开了批判性评估。自2000年10月起，37例远处进展期或不可根治性切除的胃癌患者在获得知情同意后接受了NAC，联合使用TS-1和CDDP。TS-1（80mg/m²/天）连续给药21天，随后休息14天为一个疗程，CDDP（50mg/m²）在第8天静脉滴注2小时。至少经过2个疗程的治疗后，患者接受了胃切除术及淋巴结清扫术。给药疗程的中位数为3（范围2 - 7），6例患者仅在门诊接受治疗。总缓解率为62.2%（无完全缓解（CR），但有23例部分缓解（PR）），原发灶的个体缓解率为67.6%，包括腹主动脉旁区域在内的淋巴结转移为90.5%，肝转移为50.0%，腹膜播散为14.3%。毒性反应一般较轻，未观察到与治疗相关的死亡及严重不良反应。仅2例出现4级贫血（5.4%），血液学毒性方面，1例（2.7%）患者出现3级白细胞减少，3例（8.1%）出现3级中性粒细胞减少，6例（16.2%）出现3级贫血，2例（5.4%）出现3级血小板减少。非血液学毒性方面，仅1例（2.7%）患者出现3级食欲减退和腹泻。24例患者接受了手术治疗，所有病例均进行了切除。24例中的17例（70.8%）患者接受了根治性切除。术后无严重并发症。患者在手术时间（229分钟）和出血量（365毫升）方面情况良好。术后平均住院时间为23.5天，仅出现1例吻合口漏、肠梗阻和2例胰腺炎。两年生存率为46.8%，中位生存时间为523天。总之，鉴于毒性反应、抗肿瘤效果及患者生活质量，TS-1与CDDP联合用于新辅助化疗似乎是晚期胃癌患者的一种有效治疗方式。
