CAJ | 학술논문

目的：评价培美曲塞联合顺铂二线治疗晚期胃癌的疗效及不良反应。方法选取2011年12月至2013年2月46例一线化疗失败的晚期胃癌患者，给予培美曲塞联合顺铂二线治疗，具体为：培美曲塞500mg／m2静滴，d1；顺铂25mg／m2静滴，d1～d3；21天为1周期。根据RECIST 1?0版标准评价近期疗效并计算有效率（ RR）和疾病控制率（ DCR），同时采用NCI CTC 3?0标准评价毒副反应，随访无进展生存期（ PFS）和总生存期（ OS）。结果46例均可评价近期疗效，其中无完全缓解病例，部分缓解10例，稳定12例，进展24例，RR为21?7％，DCR为47?8％。随访3～20个月，中位PFS和OS分别为3?5个月和8?4个月。全组化疗后的KPS评分为（77?6±4?3）分，高于化疗前的（65?7±5?0）分（P＜0?05），但化疗前后止痛药使用率的差异无统计学意义（ P＞0?05）。主要毒副反应为1～3级骨髓抑制和胃肠道不良反应，4级毒副反应发生率极低，仅1例4级白细胞减少；2例1级肝功能异常；患者均无肾功能异常、发热、皮疹及化疗相关性死亡。结论培美曲塞联合顺铂二线治疗晚期胃癌的疗效较好，且毒副反应轻，耐受性好。
목적：평개배미곡새연합순박이선치료만기위암적료효급불량반응。방법선취2011년12월지2013년2월46례일선화료실패적만기위암환자，급여배미곡새연합순박이선치료，구체위：배미곡새500mg／m2정적，d1；순박25mg／m2정적，d1～d3；21천위1주기。근거RECIST 1?0판표준평개근기료효병계산유효솔（ RR）화질병공제솔（ DCR），동시채용NCI CTC 3?0표준평개독부반응，수방무진전생존기（ PFS）화총생존기（ OS）。결과46례균가평개근기료효，기중무완전완해병례，부분완해10례，은정12례，진전24례，RR위21?7％，DCR위47?8％。수방3～20개월，중위PFS화OS분별위3?5개월화8?4개월。전조화료후적KPS평분위（77?6±4?3）분，고우화료전적（65?7±5?0）분（P＜0?05），단화료전후지통약사용솔적차이무통계학의의（ P＞0?05）。주요독부반응위1～3급골수억제화위장도불량반응，4급독부반응발생솔겁저，부1례4급백세포감소；2례1급간공능이상；환자균무신공능이상、발열、피진급화료상관성사망。결론배미곡새연합순박이선치료만기위암적료효교호，차독부반응경，내수성호。
Objective To evaluate the efficacy and toxicity of pemetrexed combined with cisplatin as second-line treatment in advanced gastric cancer. Methods Forty-six patients with advanced gastric cancer who had previously failed to first-line chemotherapy from December 2011 to February 2013 received pemetrexed (500mg/m2 iv, d1) combined with cisplatin (25mg/m2 iv, d1-d3) as second-line treatment. Twenty-one days was a cycle. The response evaluation criteria in solid tumors ( RECIST) 1?0 was employed to evaluate the short-term efficacy and calculated the response rate (RR) and disease control rate (DCR). The toxicity was evaluated using NCI CTC 3?0 criteria. Progression-free survival (PFS) and overall survival (OS) were calculated from the date of follow-up. Results Forty-six patients were evaluable for short-term efficacy. There were 10 cases of partial response, 12 of stable disease and 24 of progressive disease with RR of 21?7%and DCR of 47?8%. The follow-up ranged from 3 to 20 months. The median PFS and OS were 3?5 and 8?4 months, re-spectively. The KPS was 77?6±4?3 after chemotherapy, higher than 65?7±5?0 before chemotherapy, but there was no significant differ-ence on painkiller usage before and after chemotherapy. The major side effects were grade 1-3 marrow toxicities and gastrointestinal re-sponse. The incidence of grade 4 side effect was rare with only one case of grade 4 leukopenia. Two cases were grade 1 abnormal liver function. There was no renal dysfunction, fever, rash and chemotherapy-related deaths. Conclusion Pemetrexed combined with cisplatin as second-line treatment in advanced gastric cancer showed a good effect with mild toxicities and good tolerance.