Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
Gut Liver. 2010 Dec;4(4):503-7. doi: 10.5009/gnl.2010.4.4.503. Epub 2010 Dec 17.
BACKGROUND/AIMS: Elderly patients with advanced gastric cancer (AGC) have generally been excluded from clinical trials, and there are few data available on the treatment of these patients. The efficacy of palliative S-1 monotherapy as a first-line treatment regimen for elderly patients has not been well elucidated.
For this study, 25 AGC patients were enrolled between January 1, 2007 and March 31, 2009; 4 cases were recurrent AGC and 21 cases were metastatic AGC at the time of diagnosis. These patients received S-1 therapy at a dose of 40 mg/m(2) twice daily for 14 days every 3 weeks. All of the patients were older than 70 years.
The median follow-up duration, the median progression-free survival, and the overall survival time were 8.7 months (range, 4.9 to 12.5 months), 4.9 months (range, 3.5 to 6.3 months), and 10.8 months (range, 6.6 to 15.0 months), respectively. Grade 3/4 nonhematologic toxicities were rare. Grade 3/4 neutropenia was noted in two patients. The partial response rate was 21.7% and stable disease was observed in 34.8% of the patients. Two patients (8%) died due to chemotherapy-associated toxicity during treatment (septic shock/intracranial hemorrhage).
Oral S-1 chemotherapy seems to be effective as a first-line treatment regimen for elderly patients with metastatic or recurrent AGC. However, elderly patients receiving S-1 treatment should undergo continuous toxicity monitoring, since they are highly susceptible to adverse effects.
背景/目的：晚期胃癌（AGC）老年患者通常被排除在临床试验之外，关于这些患者的治疗方法数据很少。姑息性 S-1 单药治疗作为一线治疗方案在老年患者中的疗效尚未得到充分阐明。
本研究共纳入 2007 年 1 月 1 日至 2009 年 3 月 31 日期间的 25 例 AGC 患者；4 例为复发性 AGC，21 例为初诊时转移性 AGC。这些患者接受 S-1 治疗，剂量为 40mg/m2，每日 2 次，连续 14 天，每 3 周为一个周期。所有患者均大于 70 岁。
中位随访时间、中位无进展生存期和总生存期分别为 8.7 个月（范围：4.9-12.5 个月）、4.9 个月（范围：3.5-6.3 个月）和 10.8 个月（范围：6.6-15.0 个月）。3/4 级非血液学毒性罕见。两名患者出现 3/4 级中性粒细胞减少症。部分缓解率为 21.7%，稳定疾病患者占 34.8%。两名患者（8%）在治疗期间因化疗相关毒性而死亡（感染性休克/颅内出血）。
口服 S-1 化疗似乎是转移性或复发性 AGC 老年患者的有效一线治疗方案。然而，接受 S-1 治疗的老年患者应进行持续的毒性监测，因为他们易发生不良反应。
