中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2014年
11期
1081-1086
,共6页
蔡月%胡华斌%王文静%曹泰源%邓艳红
蔡月%鬍華斌%王文靜%曹泰源%鄧豔紅
채월%호화빈%왕문정%조태원%산염홍
结直肠肿瘤%伊立替康%奥沙利铂%氟尿嘧啶%近期疗效%不良反应
結直腸腫瘤%伊立替康%奧沙利鉑%氟尿嘧啶%近期療效%不良反應
결직장종류%이립체강%오사리박%불뇨밀정%근기료효%불량반응
Colorectal neoplasms%Irinotecan%Oxaliplatin%5-fluorouracil%Short-term outcomes%Adverse effects
目的 观察降低剂量的氟尿嘧啶联合奥沙利铂、伊立替康组成的改良FOLFOXIRI方案一线治疗晚期结直肠癌的安全性和有效性.方法 对中山大学附属第六医院2010年1月至2014年1月间连续收治的53例晚期结直肠癌患者采用改良FOLFOXIRI化疗方案进行治疗,其中11例联合了靶向药物治疗.按照常见不良反应分级标准(CTCAE)3.0版行安全性评价;按照实体瘤的疗效评价标准(RECIST) 1.1版进行疗效评价;采用双脱氧链终止测序法进行Kras和Braf基因检测,评估两种基因与疗效的关系.结果 全组53例患者在治疗期间,未出现治疗相关性死亡,Ⅲ～Ⅳ级不良反应发生率为32.1％(17/53),其中粒细胞下降发生率为13.2％(7/53),贫血发生率为11.3％(6/53),疲乏发生率为9.4％(5/53).44例患者获疗效评价,客观缓解率(ORR)和疾病控制率(DCR)分别为65.9％(29/44)和90.9％(40/44),R0切除率为29.5％(13/44).三药联合靶向药物治疗者ORR为72.7％(8/11),较单纯三药治疗患者(63.6％,21/33)有所提高,但差异无统计学意义(P=0.435).48例结直肠癌组织石蜡标本检测中发现,发生Kras突变者21例(43.75％),Braf突变者3例(6.25％).两种基因突变型与野生型患者的ORR和DCR的差异均无统计学意义(均P＞0.05).结论 改良FOLFOXIRI方案对晚期结直肠癌的治疗近期疗效较为满意,治疗的耐受性和安全性较好.
目的 觀察降低劑量的氟尿嘧啶聯閤奧沙利鉑、伊立替康組成的改良FOLFOXIRI方案一線治療晚期結直腸癌的安全性和有效性.方法 對中山大學附屬第六醫院2010年1月至2014年1月間連續收治的53例晚期結直腸癌患者採用改良FOLFOXIRI化療方案進行治療,其中11例聯閤瞭靶嚮藥物治療.按照常見不良反應分級標準(CTCAE)3.0版行安全性評價;按照實體瘤的療效評價標準(RECIST) 1.1版進行療效評價;採用雙脫氧鏈終止測序法進行Kras和Braf基因檢測,評估兩種基因與療效的關繫.結果 全組53例患者在治療期間,未齣現治療相關性死亡,Ⅲ～Ⅳ級不良反應髮生率為32.1％(17/53),其中粒細胞下降髮生率為13.2％(7/53),貧血髮生率為11.3％(6/53),疲乏髮生率為9.4％(5/53).44例患者穫療效評價,客觀緩解率(ORR)和疾病控製率(DCR)分彆為65.9％(29/44)和90.9％(40/44),R0切除率為29.5％(13/44).三藥聯閤靶嚮藥物治療者ORR為72.7％(8/11),較單純三藥治療患者(63.6％,21/33)有所提高,但差異無統計學意義(P=0.435).48例結直腸癌組織石蠟標本檢測中髮現,髮生Kras突變者21例(43.75％),Braf突變者3例(6.25％).兩種基因突變型與野生型患者的ORR和DCR的差異均無統計學意義(均P＞0.05).結論 改良FOLFOXIRI方案對晚期結直腸癌的治療近期療效較為滿意,治療的耐受性和安全性較好.
목적 관찰강저제량적불뇨밀정연합오사리박、이립체강조성적개량FOLFOXIRI방안일선치료만기결직장암적안전성화유효성.방법 대중산대학부속제륙의원2010년1월지2014년1월간련속수치적53례만기결직장암환자채용개량FOLFOXIRI화료방안진행치료,기중11례연합료파향약물치료.안조상견불량반응분급표준(CTCAE)3.0판행안전성평개;안조실체류적료효평개표준(RECIST) 1.1판진행료효평개;채용쌍탈양련종지측서법진행Kras화Braf기인검측,평고량충기인여료효적관계.결과 전조53례환자재치료기간,미출현치료상관성사망,Ⅲ～Ⅳ급불량반응발생솔위32.1％(17/53),기중립세포하강발생솔위13.2％(7/53),빈혈발생솔위11.3％(6/53),피핍발생솔위9.4％(5/53).44례환자획료효평개,객관완해솔(ORR)화질병공제솔(DCR)분별위65.9％(29/44)화90.9％(40/44),R0절제솔위29.5％(13/44).삼약연합파향약물치료자ORR위72.7％(8/11),교단순삼약치료환자(63.6％,21/33)유소제고,단차이무통계학의의(P=0.435).48례결직장암조직석사표본검측중발현,발생Kras돌변자21례(43.75％),Braf돌변자3례(6.25％).량충기인돌변형여야생형환자적ORR화DCR적차이균무통계학의의(균P＞0.05).결론 개량FOLFOXIRI방안대만기결직장암적치료근기료효교위만의,치료적내수성화안전성교호.
Objective To evaluate the safety and preliminary efficacy of modified FOLFOXIRI (combination of reducing dosage irinotecan,oxaliplatin and fluorouracil) in first-line treatment for patients with metastatic colorectal cancer.Method A total of 53 patients with advanced colorectal cancer receiving modified FOLFOXIRI regimen were recruited continuously from January 2010 to January 2014.Safety profile was recorded based on NCI Common Terminology Criteria for Adverse Events version 3.0 (NCI-CTCAE v3.0).Objective response was evaluated by Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) after administration of at least 4 cycles chemotherapy.Kras and Braf gene sequencing was tested by dideoxy chain-termination method.Relation between efficacy and two genes was examined.Results Among 53 patients,no treatment-related mortality was presented.The rate of grade 3 to 4 adverse event was 32.1％(17/53),including neutropenia 13.2％ (7/53),anemia 11.3％ (6/53) and fatigue 9.4％ (5/53).Overall response rate (ORR) and disease control rate(DCR) were respectively 65.9％(29/44) and 90.0％(40/44).Radical resection rate (R0) was 29.5％(13/44).Efficacy of mFOLFOXIRI regimen plus targeting therapy was assessed in 44 patients.mFOLFOXIRI regimen plus targeting therapy achieved an ORR of 72.7％(8/11),which was higher than the ORR 65.9％ (21/33) of triplet regimen alone,but the difference was not statistically significant (P=0.198).Paraffin specimens of 48 colorectal cancer cases were tested.Twenty-one cases were Kras mutant (43.75％),3 cases were Braf mutant (6.25％).There were no significant differences between two groups (P＞0.05).Conclusion Reducing dosage mFOLFOXIRI can be safely used in advanced colorectal cancer and can achieve promising results in terms of short term efficacy.
