Wilke H, Preusser P, Fink U, Gunzer U, Meyer H J, Meyer J, Siewert J R, Achterrath W, Lenaz L, Knipp H
Department of Hematology/Oncology, Hannover University, Medical School, West Germany.
J Clin Oncol. 1989 Sep;7(9):1318-26. doi: 10.1200/JCO.1989.7.9.1318.
Thirty-four patients with locally advanced, nonresectable gastric cancer (staged by laparotomy) received etoposide, Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), and cisplatin (EAP). Thirty-three patients were evaluable for response and toxicity. Second-look surgery with removal of residual tumor by gastrectomy and lymphadenectomy was performed in case of complete/partial remission (CR/PR) after EAP. After successful resection (R0- and R1-resection), two cycles of EAP were administered for consolidation therapy. Patients refusing reoperation received up to six cycles of EAP. The response rate (CR/PR) after EAP was 70% (23/33), including a 21% (7/33) rate of clinical CRs (CCRs). Two patients had minor remission (MR)/no change and seven had progressive disease. There was one early death. Nineteen of 23 responders (5 CCRs, 14 clinical PRs [CPRs]) and one patient with MR underwent second-look surgery. Five CCRs were pathologically confirmed; 10 patients with CPR were without evidence of disease (NED) after resection. In three patients (CPR), R1-resections (microscopically tumor-cell positive proximal margin) were performed; two patients are disease-free, 22+ and 33+ months after consolidation chemotherapy. In two patients, the tumor was again considered nonresectable. Twenty patients were disease-free after EAP +/- surgery +/- consolidation chemotherapy. Toxicity was primarily hematologic. Leukopenia and thrombocytopenia of World Health Organization (WHO) grade 3 occurred in 30% and 9%, respectively and grade 4 in 18% and 9% of the patients, respectively. There was no increased peri- or postoperative morbidity. After a median follow-up of 20 months for disease-free patients, the relapse rate is 60% (12/20). The median survival time for all patients is 18 months and for disease-free patients 24 months. EAP is highly effective in locally advanced gastric cancer, and offers a chance for surgery with curative intention in patients with an otherwise fatal prognosis.
34例局部晚期、不可切除的胃癌患者（经剖腹探查分期）接受了依托泊苷、阿霉素（多柔比星；阿德里亚实验室，俄亥俄州哥伦布市）和顺铂（EAP方案）治疗。33例患者可评估疗效和毒性。若EAP方案治疗后达到完全/部分缓解（CR/PR），则行二次手术，通过胃切除术和淋巴结清扫术切除残留肿瘤。成功切除（R0和R1切除）后，给予两个周期的EAP方案进行巩固治疗。拒绝再次手术的患者接受最多六个周期的EAP方案治疗。EAP方案治疗后的缓解率（CR/PR）为70%（23/33），其中临床完全缓解（CCR）率为21%（7/33）。2例患者病情轻度缓解（MR）/无变化，7例患者病情进展。有1例早期死亡。23例缓解患者中的19例（5例CCR，14例临床部分缓解[CPR]）和1例MR患者接受了二次手术。5例CCR经病理证实；10例CPR患者术后无疾病证据（NED）。3例患者（CPR）进行了R1切除（显微镜下肿瘤细胞阳性近端切缘）；2例患者在巩固化疗后22个月和33个月无疾病。2例患者肿瘤再次被认为不可切除。20例患者在EAP±手术±巩固化疗后无疾病。毒性主要为血液学毒性。世界卫生组织（WHO）3级白细胞减少和血小板减少分别发生在30%和9%的患者中，4级分别发生在18%和9%的患者中。围手术期或术后发病率无增加。无疾病患者的中位随访时间为20个月，复发率为60%（12/20）。所有患者的中位生存时间为18个月，无疾病患者为24个月。EAP方案对局部晚期胃癌高度有效，并为预后不良的患者提供了根治性手术的机会。
