摘要
目的:研究采用经动静脉联合给药的FLEP化疗法,对以淋巴结严重转移为主而不能切除的胃癌进行新辅助化疗,使病人能重新获得手术切除的机会。方法:对14例以淋巴结转移为主的晚期胃癌,以FLEP法进行新辅助化疗。内9例系未经治疗的初诊病人,术前CT检查发现第3、7、9、12组及14、16组淋巴结严重转移,难以手术治疗;5例为术后淋巴结转移性复发,或因淋巴结严重转移而进行过剖腹探查者。FLEP方案为:5-FU 370 mg/m2,iv,第1～5天;Leukovorin 30 mg,第1～5天;CDDP 70 mg/m2与Epotoside 70 mg/m2,ia,第6、20天,每5周重复1次。每一病例视病情进行2～3个疗程的治疗。结果:所有病例症状都明显改善。初次就诊的9例CT评价无变化(NC)1例,未行手术;部分缓解(PR)8例,均进行了胃次全、全胃或联合脏器切除,淋巴结清扫采取了D2加重点淋巴结、D3加第16组淋巴结手术,手术切除率为88.9%,手术治疗的病例均生存至今,最长者已达26个月。在3例术后出现淋巴结转移性复发者及2例因淋巴结严重转移初次手术未能切除者影象学评价PR 3例,病变进展PD 1例,均未再手术治疗。其中2例分别于治疗开始后的8、15个月死亡,另3例至今已生存3～15个月。结论:FLEP新辅助化疗法对于以淋巴结严重转移为主的胃癌具非常显著的治疗效果,可使严重或有远处淋巴结转移的胃癌病人重新获得手术治疗的机会。
Objective To elucidate the efficacy of FLEP regimen, used as neoadjuvant chemotherapy for unreseetable gastric cancer with advanced abdominal lymph node metastasis. Methods FLEP regimen： 5-FU 370mg/m^2, iv. davl-5： Leukovorin 30mg. dayl-5： CDDP 70mg/m^2 and Epotoside 70mg/m^2. ia, day 6 and 20, The regimen was administered to 14 patients with unresectable gastric cancer with advanced lymph node metastasis. Computer tomography （CT） revealed advanced metastasis in LN Stations No.8,9,12,13,14 and 16 with main blood vessel（s） or adjacent structure（s） involved in 9 of the 14 patients： the other 5 patients suffered from recurrent lymph nodes metastases after previous abdominal exploration. Results The general conditions and symptoms of the patients improved evidently after the treatment. On CT examination, of the 9 patientes, only one showed NC （no change） and remained nonresectable, 8 of them （88.9%） showed PR （partial remission） and were performed tectal gastrectom3. subtotal gastrectomy or combined gastrectomy, with D2＋α or D3＋No.16 lymphadenectomy successfully： the operated patients all survived up to present, the longest record being 26 months. In the other 5 patients, only one showed no response： no operations were performed in all these patients. Two patients died in the 8th and the 15th month after chemotherapy; the other 3 remained alive till now, with the longest survival record being 15 months. Conclusions The FLEP regimen produces an evident effect on gastric cancer patients with advanced lymph node metastasis and could downstage a number of these patients and give them another chance for surgery.
出处
《外科理论与实践》
2005年第5期425-428,共4页
Journal of Surgery Concepts & Practice
关键词
胃肿瘤
肿瘤转移
化学疗法
辅助
Gastric cancer
Lymph nodes metastasis
Neoadjuvant chemotherapy
