Hiraishi M, Konishi T, Makuuchi M
Second Dept. of Surgery, Faculty of Medicine, University of Tokyo.
Gan To Kagaku Ryoho. 1995 Jul;22(8):994-1000.
Sequential MTX/5-FU therapy was performed on 64 patients with unresectable or recurrent gastric cancer. The therapy was most effective in patients with poorly differentiated type gastric cancer. We adopted the intermediate (MTX: 100mg/m2, 5-FU: 800mg/m2) and low (MTX: 30mg/m2, 5-FU: 600 mg/m2) dose regimens. The latter was performed at the outpatient clinic every 2 weeks. This therapy was used for patients with Borrmann type 4 gastric cancer or advanced gastric cancer of poorly differentiated type as postoperative adjuvant chemotherapy. The response rate was 25% in 44 evaluable patients, and 33% in patients with poorly differentiated type cancer. As an adverse effect, leukopenia (grade 3, 4) was observed in 4 patients (9%). The 5-year cumulative survival rate of the sequential MTX/5-FU therapy group (52.6%) was much better than the conventional adjuvant chemotherapy group (32.1%) in patients who underwent curative resection with Borrmann type 4 gastric cancer. One patient survived more than 900 days after non-curative resection with peritoneal dissemination (P 3) after low dose therapy of sequential MTX/5-FU. For the patients who did not respond to the MTX/5-FU therapy, MTX/CDDP/LV/5-FU therapy was adopted. This protocol consisted of MTX (30 mg/m2 iv; day 1), CDDP (60 mg/m2 div; day 2 and day 9), Leucovorin (30 mg iv; day 2-9) and 5-FU (250 mg/m2 div; day 2-9). We also performed MTX/CDDP/LV/5-FU therapy for the treatment of differentiated type gastric cancer.
对64例无法切除或复发的胃癌患者进行了甲氨蝶呤（MTX）/氟尿嘧啶（5-FU）序贯治疗。该治疗对低分化型胃癌患者最有效。我们采用了中剂量（MTX：100mg/m²，5-FU：800mg/m²）和低剂量（MTX：30mg/m²，5-FU：600mg/m²）方案。后者每2周在门诊进行一次。该治疗用于Borrmann 4型胃癌或低分化型晚期胃癌患者的术后辅助化疗。44例可评估患者的缓解率为25%，低分化型癌症患者的缓解率为33%。作为不良反应，4例患者（9%）出现3级、4级白细胞减少。在接受Borrmann 4型胃癌根治性切除的患者中，MTX/5-FU序贯治疗组的5年累积生存率（52.6%）远高于传统辅助化疗组（32.1%）。1例患者在接受MTX/5-FU低剂量序贯治疗后，出现腹膜播散（P 3）非根治性切除后存活超过900天。对于对MTX/5-FU治疗无反应的患者，采用MTX/顺铂（CDDP）/亚叶酸钙（LV）/5-FU治疗。该方案包括MTX（30mg/m²静脉注射；第1天）、CDDP（60mg/m²分剂量；第2天和第9天）、亚叶酸钙（30mg静脉注射；第2 - 9天）和5-FU（250mg/m²分剂量；第2 - 9天）。我们也采用MTX/CDDP/LV/5-FU治疗分化型胃癌。
