Wöhrer S S, Raderer M, Hejna M
Department of Internal Medicine I, Division of Oncology, University of Vienna, Vienna, Austria.
Ann Oncol. 2004 Nov;15(11):1585-95. doi: 10.1093/annonc/mdh422.
More than two-thirds of patients diagnosed with gastric cancer will have unresectable disease. They present a difficult problem to clinicians as to whether to choose a strictly supportive approach or expose patients to the side-effects of a potentially ineffective treatment. The objective of this article is to review the clinical trials utilizing cytotoxic chemotherapy in patients with advanced gastric cancer.
A computerized (Medline) search was carried out to identify papers published on this topic between 1966 and 2003. Only articles with an English abstract were reviewed, and studies only presented in abstract form were not included in the analysis.
A total of 101 trials were subsequently identified. Four randomized trials compared palliative chemotherapy with best supportive care in 174 patients with advanced gastric cancer. Effectiveness and side-effects were evaluated in 73 phase II studies and 24 randomized phase III trials.
Analysis of results shows chemotherapy to be superior to best supportive care alone. Combination chemotherapy compared with monochemotherapy is associated with significantly higher overall (complete plus partial) response rates but nevertheless results in similar survival. ECF (epirubicin, cisplatin and 5-fluorouracil) currently represents one of the most effective regimens for advanced gastric cancer, whereas among the newer combinations, irinotecan- or taxane-based regimens have also given promising results. In patients with a poor performance status, consideration could be given to leucovorin-modulated 5-fluorouracil alone. Prognosis for the majority of patients, however, remains poor, as increases in survival were moderate at best.
超过三分之二被诊断为胃癌的患者会出现无法切除的疾病。这给临床医生带来了一个难题，即究竟是选择严格的支持性治疗方法，还是让患者承受潜在无效治疗的副作用。本文的目的是回顾在晚期胃癌患者中使用细胞毒性化疗的临床试验。
通过计算机（Medline）检索，以确定1966年至2003年间发表的关于该主题的论文。仅对带有英文摘要的文章进行回顾，仅以摘要形式呈现的研究不纳入分析。
随后共确定了101项试验。四项随机试验比较了174例晚期胃癌患者接受姑息化疗与最佳支持治疗的效果。在73项II期研究和24项随机III期试验中评估了有效性和副作用。
结果分析表明，化疗优于单纯的最佳支持治疗。联合化疗与单一化疗相比，总体（完全缓解加部分缓解）缓解率显著更高，但生存率相似。ECF（表柔比星、顺铂和5-氟尿嘧啶）目前是晚期胃癌最有效的治疗方案之一，而在新的联合方案中，基于伊立替康或紫杉烷的方案也取得了有前景的结果。对于身体状况较差的患者，可以考虑单独使用亚叶酸钙调节的5-氟尿嘧啶。然而，大多数患者的预后仍然很差，因为生存率的提高充其量只是适度的。
