Ollivier S, Fonck M, Bécouarn Y, Brunet R
Institut Bergonié, Regional Cancer Center, Department of Medicine, Bordeaux, France.
Am J Clin Oncol. 1998 Jun;21(3):237-40. doi: 10.1097/00000421-199806000-00005.
Chemotherapy of neuroendocrine tumors must be improved. The most widely used regimen, which combines streptozotocin with fluorouracil, commonly obtains poor results. The best response rate that has been reported for carcinoid tumors is 33%. From July 1991 through September 1994, 18 patients who had advanced neuroendocrine tumors-including nine carcinoid tumors, seven neuroendocrine tumors of unknown primary site, one insulinoma, and one paraganglioma-were treated with a regimen of dacarbazine, 400 mg/m2/day, plus fluorouracil, 1 g/m2/day, with leucovorin, 200 mg/m2/day, for 2 days every 21 days (DTIC-LVFU2 protocol). The results were assessed according to the World Health Organization criteria of toxicity and response. Toxicity was moderate. The most severe side effects were grade 3 vomiting in two patients, grade 3 leukopenia in three patients, and grade 3 mucositis in one patient. The overall response rate was 27%, with only one partial response for carcinoid tumors but one complete and three partial responses for the other tumor types. Efficacy was insufficient in patients who had carcinoid tumors but the combination of dacarbazine with fluorouracil and leucovorin could be an effective regimen for the treatment of neuroendocrine tumors of unknown primary site.
神经内分泌肿瘤的化疗必须加以改进。最广泛使用的方案是链脲佐菌素与氟尿嘧啶联合使用，但通常效果不佳。类癌肿瘤报告的最佳缓解率为33%。从1991年7月至1994年9月，18例晚期神经内分泌肿瘤患者——包括9例类癌肿瘤、7例原发部位不明的神经内分泌肿瘤、1例胰岛素瘤和1例副神经节瘤——接受了达卡巴嗪（400mg/m²/天）加氟尿嘧啶（1g/m²/天）并联合亚叶酸钙（200mg/m²/天）的方案治疗，每21天进行2天（DTIC-LVFU2方案）。根据世界卫生组织的毒性和缓解标准对结果进行评估。毒性为中度。最严重的副作用是2例3级呕吐、3例3级白细胞减少和1例3级黏膜炎。总体缓解率为27%，类癌肿瘤仅有1例部分缓解，而其他肿瘤类型有1例完全缓解和3例部分缓解。该方案对类癌肿瘤患者疗效不足，但达卡巴嗪与氟尿嘧啶和亚叶酸钙联合使用可能是治疗原发部位不明的神经内分泌肿瘤的有效方案。
