Efficacy of sequential methotrexate and 5-fluorouracil (MTX/5FU) in improving oral intake in patients with advanced gastric cancer with severe peritoneal dissemination
Efficacy of sequential methotrexate and 5-fluorouracil (MTX/5FU) in improving oral intake in patients with advanced gastric cancer with severe peritoneal dissemination
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DOI：
10.1007/s10120-009-0517-8
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发表时间：
2009-10-01
期刊：
影响因子：
7.4
通讯作者：
Taku, Keisei
中科院分区：
文献类型：
--
作者：
Imazawa, Masako;Kojima, Takashi;Taku, Keisei
虽然胃癌腹膜播散很常见，并且经常导致患者病情和生活质量（QOL）恶化，但这些患者通常被排除在临床试验之外。回顾性分析31例胃癌严重腹膜转移患者接受MTX/5-FU序贯治疗的临床疗效和毒副反应。治疗方案包括每周给予MTX（100 mg/m2），随后给予5 FU（600 mg/m2）。MTX给药后24 h开始给予甲酰四氢叶酸（10 mg/m2），每6 h给药6次，中位生存期为255 d，中位无进展生存期为127 d。在21例具有可测量病变的患者中，4例（19%）患者达到部分缓解。26例腹水患者中有14例（54%）的腹水体积明显减少。17名患者有足够的口服摄入，但其他14名患者在治疗前需要营养支持。前17例患者中位无输液生存期为100天，后14例患者中3例（21%）口服摄入量改善。在26%的患者中观察到3级或4级中性粒细胞减少，在45%的患者中观察到贫血。3级非血液学毒性为呕吐（6%）和疲乏（10%）。MTX/5 FU联合化疗可有效治疗胃癌腹膜转移，并可减少腹水，改善患者的口服情况。
Although peritoneal dissemination of gastric cancer is common and often causes deterioration of the patient's condition and quality of life (QOL), these patients are usually excluded from clinical trials. We retrospectively investigated the clinical benefit and toxicity of sequential methotrexate and 5-fluorouracil (MTX/5FU) therapy for patients with peritoneal dissemination.The subjects were 31 patients with severe peritoneal dissemination of gastric cancer who were treated with MTX/5FU. The treatment schedule comprised weekly administration of MTX (100 mg/m(2)) followed by 5FU (600 mg/m(2)). Leucovorin (10 mg/m(2)) was administered six times, every 6 h, starting 24 h after MTX administration.The median survival time was 255 days, and the median progression-free survival was 127 days. Of the 21 patients with measurable lesions, 4 (19%) patients achieved a partial response. Ascites volume decreased markedly in 14 (54%) of the 26 patients with ascites. Seventeen patients had adequate oral intake, but the other 14 patients had required nutritional support before treatment. The median dripinfusion free survival was 100 days in the former 17 patients, and oral intake improved in 3 (21%) of the latter 14 patients. Grade 3 or 4 neutropenia was observed in 26% of the patients and anemia was observed in 45%. The grade 3 nonhematological toxicities were vomiting (6%) and fatigue (10%). Early death, within 30 days of the last administration of MTX/5FU, occurred due to disease progression in 2 patients, but there were no treatment-related deaths.MTX/5FU chemotherapy may be effective in treating peritoneal dissemination of gastric cancer and might improve the patient's condition in terms of reducing ascites and improving oral intake.