Moertel C G, Gunderson L L, Mailliard J A, McKenna P J, Martenson J A, Burch P A, Cha S S
Mayo Clinic, Rochester, MN 55905.
J Clin Oncol. 1994 Jan;12(1):21-7. doi: 10.1200/JCO.1994.12.1.21.
To develop a tolerable regimen of fluorouracil (5-FU), low-dose leucovorin, and radiation, and to obtain an early estimate of therapeutic effectiveness.
Forty patients with locally unresectable or recurrent gastrointestinal carcinoma were studied (pancreas, n = 22; rectum and sigmoid, n = 10; gastric, n = 6; other, n = 2). Irradiation therapy was administered in 1.8-Gy fractions 5 days per week, with total doses ranging from 45 to 54 Gy. 5-FU 400 mg/m2/d plus leucovorin 20 mg/m2/d, both by rapid intravenous injection, were administered for 3 or 4 days during the first and fifth weeks of radiation. 5-FU 425 mg/m2/d plus leucovorin 20 mg/m2/d were administered for 4 days at 4 weeks following radiation and for 5 days at 9 weeks.
Major toxicities with upper abdominal treatment were nausea, vomiting, weight loss, and leukopenia. A tolerable dosage regimen was radiation at 45 Gy with 4 days of 5-FU plus leucovorin during the first week and 3 days during the last week with postradiation chemotherapy. Major toxicities with pelvic radiation were diarrhea and leukopenia. A tolerable regimen was 54 Gy with 4 days of 5-FU plus leucovorin during the first and fifth week followed by the postradiation chemotherapy. Median survival durations for pancreatic and rectal/sigmoid carcinomas are 13 months and 31 months, respectively. Five patients have no evidence of disease from 38 to 50 months after the onset of therapy (rectal, n = 2; stomach, n = 2; pancreas, n = 1).
We have developed patient-tolerable regimens for combined 5-FU plus leucovorin followed by radiation to the abdomen and to the pelvis. The favorable results observed in locally unresectable disease allow cautious optimism for possible effectiveness in the surgical adjuvant setting, a possibility currently being tested in national trials of rectal and gastric carcinoma.
制定一种可耐受的氟尿嘧啶（5-FU）、低剂量亚叶酸钙和放疗方案，并尽早评估治疗效果。
对40例局部无法切除或复发的胃肠道癌患者进行了研究（胰腺，n = 22；直肠和乙状结肠，n = 10；胃，n = 6；其他，n = 2）。放疗每周5天，每次1.8 Gy，总剂量为45至54 Gy。在放疗的第一周和第五周，5-FU 400 mg/m²/天加亚叶酸钙20 mg/m²/天，均通过快速静脉注射给药3或4天。放疗后4周给予5-FU 425 mg/m²/天加亚叶酸钙20 mg/m²/天，持续4天，放疗后9周给予5天。
上腹部治疗的主要毒性反应为恶心、呕吐、体重减轻和白细胞减少。一种可耐受的剂量方案是45 Gy放疗，在第一周给予4天5-FU加亚叶酸钙，在最后一周给予3天，并进行放疗后化疗。盆腔放疗的主要毒性反应为腹泻和白细胞减少。一种可耐受的方案是54 Gy放疗，在第一周和第五周给予4天5-FU加亚叶酸钙，随后进行放疗后化疗。胰腺癌和直肠/乙状结肠癌的中位生存期分别为13个月和31个月。5例患者在治疗开始后38至50个月无疾病证据（直肠，n = 2；胃，n = 2；胰腺，n = 1）。
我们已经制定了患者可耐受的5-FU加亚叶酸钙联合放疗方案，用于腹部和盆腔放疗。在局部无法切除的疾病中观察到的良好结果，使人们对其在手术辅助治疗中的有效性持谨慎乐观态度，目前正在全国范围内的直肠癌和胃癌试验中对这一可能性进行测试。
