Kobayashi Michiya, Tsuburaya Akira, Nagata Naoki, Miyashita Yumi, Oba Koji, Sakamoto Junichi
Department of Tumor Surgery, Kochi Medical School, Kohasu, Japan.
Gastric Cancer. 2006;9(2):114-9. doi: 10.1007/s10120-006-0364-9.
The most frequent recurrence pattern of advanced gastric cancer is peritoneal dissemination. We investigated the safety of and compliance with sequential chemotherapy consisting of paclitaxel and S-1, both of which are effective in the treatment of peritoneal dissemination.
The patients in the study all had histologically proven gastric cancer, classified according to the TNM and the Japanese criteria for gastric cancer as T3-4, N0-2, P0, H0 M0, and CY0-1. In all patients, standard gastrectomy of more than a D2 dissection was performed. A dose of 80 mg/m2 of paclitaxel was administered for three courses. One course comprised weekly administration for 3 weeks, followed by a 1-week rest, except for the first course (following S-1 administration at 80 mg/m2 body surface area), in which paclitaxel was administered for only 2 weeks, followed by a 1-week rest. S-1 was administered from day 78 for four courses, with one course comprising 2 weeks' administration followed by a 1-week rest. Fifty patients received paclitaxel chemotherapy. The median age was 62.5 years overall; among the 34 male patients it was 65.5 years, and among the female patients it was 48.0 years.
The patient compliance rate was 84%. There were no cases of grade 4 hematological toxicity during either paclitaxel or S-1 treatment. With respect to nonhematological toxicities, there was one case of grade 3 neuropathy during the course of paclitaxel treatment and one case of grade 3 diarrhea during the course of S-1 treatment. These patients recovered and completed the scheduled treatment regimen.
Sequential chemotherapy of paclitaxel and S-1 as postoperative adjuvant chemotherapy for advanced gastric cancer is feasible.
晚期胃癌最常见的复发模式是腹膜播散。我们研究了由紫杉醇和S-1组成的序贯化疗的安全性和依从性，这两种药物在治疗腹膜播散方面均有效。
本研究中的患者均经组织学证实为胃癌，根据TNM和日本胃癌标准分类为T3-4、N0-2、P0、H0 M0和CY0-1。所有患者均接受了超过D2淋巴结清扫的标准胃切除术。给予80mg/m²的紫杉醇，共三个疗程。一个疗程包括每周给药3周，然后休息1周，但第一个疗程（在体表面积80mg/m²给予S-1后）除外，其中紫杉醇仅给药2周，然后休息1周。从第78天开始给予S-1，共四个疗程，一个疗程包括给药2周，然后休息1周。50例患者接受了紫杉醇化疗。总体中位年龄为62.5岁；34例男性患者中为65.5岁，女性患者中为48.0岁。
患者依从率为84%。在紫杉醇或S-1治疗期间均无4级血液学毒性病例。关于非血液学毒性，在紫杉醇治疗过程中有1例3级神经病变，在S-1治疗过程中有1例3级腹泻。这些患者均康复并完成了预定的治疗方案。
紫杉醇和S-1序贯化疗作为晚期胃癌术后辅助化疗是可行的。
