von Schrenck T, Howard J M, Doppman J L, Norton J A, Maton P N, Smith F P, Vinayek R, Frucht H, Wank S A, Gardner J D
Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
Gastroenterology. 1988 Jun;94(6):1326-34. doi: 10.1016/0016-5085(88)90670-1.
Ten consecutive patients with metastatic gastrinoma that increased in size over time were studied prospectively during treatment with monthly cycles of streptozotocin (3 g/m2), 5-fluorouracil (1.2 g/m2), and adriamycin (40 mg/m2) to determine the response rate and time-courses of changes during chemotherapy and to assess various methods of evaluating the effect of chemotherapy. Forty percent of patients demonstrated an initial objective response (greater than or equal to 25% decrease in tumor size with no new lesions) and 60% failed chemotherapy (greater than or equal to 25% increase in tumor size or appearance of new lesions). The mean dose of streptozotocin was 27 g/m2 with objective responses occurring at 3.7 +/- 0.7 mo and failures at 4.5 +/- 0.7 mo. Responses lasted 9.7 +/- 2.8 cycles and no complete responses occurred. Survival was not significantly different in responders versus nonresponders (26 +/- 11 vs. 15 +/- 4.8 mo, p greater than 0.1). Changes in serum gastrin concentration, basal acid output, or sensitivity to a given dose of histamine H2-receptor antagonist did not reflect changes in tumor size. Computed tomography and angiography were the best methods to assess changes in tumor size during chemotherapy, whereas liver-spleen scan and ultrasound were relatively insensitive. All patients developed side effects with chemotherapy: 100% had vomiting, 80% alopecia, 40% transient proteinuria, and 20% leukopenia. The present results indicate that chemotherapy with streptozotocin, 5-fluorouracil, and adriamycin is much less effective in patients with extensive metastatic gastrinoma than previously reported. Computed tomography scanning is the method of choice to assess changes in tumor size. Changes in serum gastrin concentration, acid secretion, or tumor size assessed by liver-spleen scan or ultrasound are not sensitive indicators of the tumor response during chemotherapy.
对10例随着时间推移肿瘤大小增加的转移性胃泌素瘤患者进行了前瞻性研究，治疗方案为每月使用链脲佐菌素（3 g/m²）、5-氟尿嘧啶（1.2 g/m²）和阿霉素（40 mg/m²）的周期，以确定化疗期间的缓解率和变化的时间进程，并评估评估化疗效果的各种方法。40%的患者表现出初始客观缓解（肿瘤大小减少大于或等于25%且无新病灶），60%的患者化疗失败（肿瘤大小增加大于或等于25%或出现新病灶）。链脲佐菌素的平均剂量为27 g/m²，客观缓解发生在3.7±0.7个月，失败发生在4.5±0.7个月。缓解持续9.7±2.8个周期，未出现完全缓解。缓解者与未缓解者的生存率无显著差异（26±11个月对15±4.8个月，p大于0.1）。血清胃泌素浓度、基础胃酸分泌量或对给定剂量组胺H2受体拮抗剂的敏感性变化未反映肿瘤大小的变化。计算机断层扫描和血管造影是评估化疗期间肿瘤大小变化的最佳方法，而肝脾扫描和超声相对不敏感。所有患者化疗均出现副作用：100%有呕吐，8
