| Objective:Gastric cancer is one of the most common malignant tumors with higher mortality. Most patients were found in advanced stage and lost the chances of surgical operation. Therefore, combined chemotherapy plays a leading role in the treatment of gastric cancer in clinic. Two kinds of medicine, cell cycle nonspecific agent (CCNSA) and cell cycle specific agents (CCSA), are common used in chemotherapy scheme with advanced gastric cancer as other malignancies. Diamminedichloroplatinum (DDP) is the most frequently used drug of CCNSA, it is often combined with CCSA to treat gastric cancer. The drugs of plant alkaloid, hydroxycamptothecin (HCPT) belongs to CCSA that have rapidly developed in recent years. This research is focus on the recent efficacy and toxicity reaction of Hydroxycamptothecin-based combined chemotherapy in advanced gastric cancer.Methods:A total of 119 patients with advanced gastric cancer were randomly divided into treatment group and control group, 59 cases in treatment groupand 60 cases in treatment group. Of them, 51 have been staged as TNM III cases 68 TNM IV cases.53 patients were the first time to be treated,66 had been treated before.The chemotherapy scheme of treatment group : HCPT 10 mg d 1-5, CF 100 mg d 1.5, 5-Fu 500 mg/m2 d 1-5, and DDP 30 mg/ m2 d1-3, three weeks per cycle. The chemotherapy scheme of control group: CF 100 mg d1-5, 5-Fu 500 mg/m2 d1-5, and DDP 30 mg/ m2 d1-3, three weeks per cycle. To evaluate the efficacy and analyze the toxicity reaction after a full review three cycles later. Objective evaluation is based on RECIST (the Response Evaluation Criteria in Solid Tumors) of NCI (National Cancer Institute) :①complete remission (CR) : Disappearance of all target lesions,lasting at least four weeks,②partial response (PR): At least a 30% decrease in the sum of the LD(long-diameter) of target lesions, taking as reference the baseline sum LD.③stable disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started,④progressive disease (PD): At least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. Grades from zero to fourth are divided by the CTC( Common Toxicity Criteria) of NCI reference of acute and subacute toxicity of anticancer drugs. The toxic reaction is calculated by cycle number of chemotherapy. All statistics were completed with SPSS 11.0, with test level atα= 0.05.Results:The response rate of the recent efficacy of the treatment group is 47.5% (28 /59). The response rate of the recent efficacy of the stage III is 50.0% (13/26) , The response rate of the recent efficacy of the stage IV is 45. 5%( 15/33), respectively. Response rate of the recent efficacy of the control group is 28.3% (17/60). The response rate of the recent efficacy of the stage III is 24.1% (7/29) , the response rate of the recent efficacy of the stage IV is 32. 3% (10/31) . Response rate has statistically significant difference between the two groups,which is verified by x2 test(x2 =4.63 , P<0.05) . Response rate of patients in stage III has statistically difference between the two groups ( x2 =3. 96 , P<0.05). Response rate of patients in stage III has no difference between the two groups( x2 =1.17 , P>0.05). Response rate of patients has no difference between the two groups of first been treated ( x2 =2. 27 , P>0. 05). Response rate of patients also has no difference between the two groups of been treated before ( x2 =2. 92, P>0. 05). Six monthes survival ratio of the two groups has difference(x2 =6.19 , P<0.05).Fifty nine patients of the treatment group received a total of 283 cycles of chemotherapy, the number of the control group is 289. The main toxic reactions are nausea, vomiting, diarrhea, leukopenia, thrombocytopenia, anaemia, abnormal liver function, renal dysfunction, abnormal ECG and the oral mucosa inflammation, Most of which are grade from one to two and normalize after treating. The difference was statistically non-significant between the quantity of toxic reaction cycles of chemotherapy after the x2 test.Conclusion:HCPT-based combined chemotherapy is effective,safe,can increase survival ratio and suitable for advanced gastric cancer.
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