Takahashi Tsunehiro, Saikawa Yoshiro, Yoshida Masashi, Kitagawa Yuko, Otani Yoshihide, Kubota Tetsuro, Kumai Koichiro, Kitajima Masaki
Department of Surgery, School of Medicine, Keio University, Tokyo 160-8582, Japan.
Anticancer Res. 2006 Mar-Apr;26(2B):1631-5.
The surgical outcome for advanced gastric cancer, even following curative surgery, is associated with a poor prognosis. A pilot study in advanced gastric cancer patients was carried out using pre-operative chemotherapy with S-1 and low-dose cisplatin (CDDP) (TSLD).
Twenty-one patients with stage IV gastric cancer were treated with TSLD as the initial treatment, after informed consent had been obtained. Surgery was performed when curative resection was deemed feasible in selected patients who showed improvement in their tumors. Other regimens including CPT-11 or taxanes were utilized as second-line chemotherapy when the tumor showed no change or progressive disease following TSLD therapy.
No patient had a complete response, while 11 had partial responses following TSLD therapy, yielding an overall response rate of 52.4%. Fifteen out of 21 (71.4%) underwent surgery following TSLD therapy, while curative surgery determined by histological investigation was performed in 10 out of 15 (47.6%) patients. No grade 4 toxicities or treatment-related deaths were observed. The following grade 3 toxicities were observed: neutropenia (6 patients), thrombocytopenia (1 patient) and anemia (1 patient). The other toxicities observed, including gastrointestinal toxicity, were grade 2 or less. The median survival time of all patients was 526 days, and 1- and 2-year survival rates were 64.9% and 41.7%, respectively.
TSLD is a potent regimen with a low toxicity profile for highly advanced gastric cancer.
晚期胃癌即使接受了根治性手术，其手术结果仍与预后不良相关。对晚期胃癌患者开展了一项初步研究，采用术前S-1与低剂量顺铂（CDDP）联合化疗（TSLD）。
21例IV期胃癌患者在获得知情同意后，接受TSLD作为初始治疗。在选定的肿瘤状况有所改善的患者中，当认为可行根治性切除时即进行手术。当肿瘤在TSLD治疗后无变化或出现疾病进展时，采用包括伊立替康或紫杉烷类的其他方案作为二线化疗。
TSLD治疗后，无患者完全缓解，11例部分缓解，总缓解率为52.4%。21例患者中有15例（71.4%）在TSLD治疗后接受了手术，其中15例患者中有10例（47.6%）经组织学检查确定进行了根治性手术。未观察到4级毒性反应或与治疗相关的死亡。观察到以下3级毒性反应：中性粒细胞减少（6例患者）、血小板减少（1例患者）和贫血（1例患者）。观察到的其他毒性反应，包括胃肠道毒性反应，均为2级或以下。所有患者的中位生存时间为526天，1年和2年生存率分别为64.9%和41.7%。
对于高度晚期胃癌，TSLD是一种毒性较低的有效方案。
