Shitara Kohei, Takahari Daisuke
Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.
Case Rep Oncol. 2010 Jul 21;3(2):262-267. doi: 10.1159/000319169.
The prognosis of advanced gastric cancer patients, especially those with poor performance status (PS), is generally dismally poor. Patients with PS 3-4 are usually ineligible for participation in clinical studies and are managed with only best supportive care. Case Report: A 63-year-old male with advanced gastric cancer was admitted to our hospital. His PS was markedly impaired (Eastern Cooperative Oncology Group PS 4), with dyspnea secondary to lymphangitis, pleuritis and pericarditis). He also had bilateral leg paralysis due to multiple bone metastases. He was treated with chemotherapy using 5-fluorouracil and leucovorin for 14 days with pericardial drainage followed by intrapericardial infusion of cisplatin. He was also treated with radiotherapy for bone metastasis. The patient required 5 l/min oxygen therapy at the start of chemotherapy, but his dyspnea was improved by day 14 and he no longer required supplemental oxygen therapy. His leg paralysis also improved with the radiation therapy. His PS was significantly improved with this multimodal treatment modality, and he was ultimately discharged with chemotherapy with oral fluoropyrimidine. CONCLUSION: This case suggests that multimodal therapy including chemotherapy may be beneficial in advanced gastric cancer patients even in the setting of poor PS. Further study might be required to confirm the benefit of chemotherapy in this patient population.
晚期胃癌患者的预后，尤其是那些身体状况较差（PS）的患者，通常非常糟糕。PS评分为3 - 4的患者通常没有资格参加临床研究，仅接受最佳支持治疗。病例报告：一名63岁的晚期胃癌男性患者入住我院。他的PS明显受损（东部肿瘤协作组PS 4），因淋巴管炎、胸膜炎和心包炎继发呼吸困难。他还因多处骨转移导致双侧腿部瘫痪。他接受了为期14天的5 - 氟尿嘧啶和亚叶酸钙化疗，并进行心包引流，随后心包内注入顺铂。他还接受了骨转移放疗。化疗开始时患者需要5升/分钟的氧疗，但到第14天时呼吸困难得到改善，不再需要补充氧疗。放疗后他的腿部瘫痪也有所改善。通过这种多模式治疗方式，他的PS显著改善，最终出院并接受口服氟嘧啶化疗。结论：该病例表明，即使在PS较差的情况下，包括化疗在内的多模式治疗对晚期胃癌患者可能有益。可能需要进一步研究来证实化疗对该患者群体的益处。
