Bleomycin alone and in Combination with Methotrexate in the Treatment of Carcinoma of the Esophagus.
Bleomycin alone and in Combination with Methotrexate in the Treatment of Carcinoma of the Esophagus.
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博莱霉素单独使用以及与甲氨蝶呤联合治疗食管癌。
DOI：
10.1177/030089167406000107
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发表时间：
1974
期刊：
影响因子：
1.9
通讯作者：
G. Bonadonna
中科院分区：
文献类型：
--
作者：
G. Tancini;E. Bajetta;G. Bonadonna
本文回顾了29例晚期食管癌患者单用博莱霉素（BLM）和5例联合甲氨蝶呤（MTX）治疗的结果。如先前出版物所述，以五种不同的剂量方案静脉注射药物（表1）。在组合中，BLM以10 mg/m2/周的剂量每周两次静脉内给药1个月。间隔2-3周后重复疗程。在34例单独或联合给予BLM的患者中，23例未经治疗。单独用BLM治疗的组中的总体反应为52%（表2）。完全缓解1例，缓解50%以上3例（CR + PR > 50%：14%）.采用首次给药方案时观察到的应答发生率最高（3/3）。第五种方案与日本研究者使用的方案相似（10 mg/m2，每周两次），在7/17例患者中诱导消退。不同治疗方案的中位缓解持续时间范围为1至2个月。在用BLM + MTX治疗的小系列中，4/5的患者显示消退（CR 1，PR > 50% 2），中位持续时间为2.7个月。在仅用BLM治疗的患者中，在最小80 mg/m2和最大220 mg/m2后，在12/29名患者（41%）中观察到通过重复胸部X射线证实的肺毒性。与5个治疗方案相关的肺毒性极高发生率如下：第一个方案3/3，第二个方案1/3，第三个方案1/3，第四个方案2/3，第五个方案5/17。在2例患者（均接受首个给药方案治疗）中，肺毒性导致死亡（总剂量120 mg/m2）。该报告显示，单独使用BLM可使约50%的晚期食管表皮样癌患者的肿瘤消退。然而，质量和持续时间的回归未能表明在本系列的一个有用的作用，BLM在控制食管癌。BLM与MTX的组合可能值得进一步试验。
The therapeutic results of Bleomycin (BLM) administered alone (29 patients) and in combination with Methotrexate (5 patients) in advanced carcinoma of the esophagus are reviewed. The drug was injected intravenously in five different dose schedules (table 1), as described in previous publications. In combination BLM was given twice weekly at the dose of 10 mg/m2/week intravenously for 1 month. Courses were repeated after an interval of 2–3 weeks. Of 34 patients given BLM alone or in combination, 23 were untreated. The overall response in the group treated with BLM alone was 52 % (table 2). However, complete remission was seen only in 1 patient and more than 50 % remission in 3 patients (CR + PR > 50 %: 14 %). The highest incidence of response was observed with the first dose schedule employed (3/3). The fifth schedule, which is similar to that used by Japanese investigators (10 mg/m2 twice weekly) induced regression in 7/17 patients. The median duration of response ranged in the different schedules from 1 to 2 months. In the small series treated with BLM + MTX 4/5 patients showed regression (CR 1, PR > 50 % 2) with a median duration of 2.7 months. In patients treated with BLM alone pulmonary toxicity confirmed through repeated chest X-rays was observed in 12/29 patients (41 %) after a minimum of 80 mg/m2 and a maximum of 220 mg/m2. This exceedingly high incidence of lung toxicity in relation to the five treatment schedules was as follows: first schedule 3/3, second 1/3, third 1/3, fourth 2/3, fifth 5/17. In 2 patients (both treated with the first dose-schedule) pulmonary toxicity contributed to the cause of death (total dose 120 mg/m2). This report shows that BLM alone produced regressions in about 50 % of patients with advanced epidermoid carcinoma of the esophagus. However, both quality and duration of regression failed to indicate in the present series a useful role of BLM in the control of esophageal carcinoma. The combination of BLM with MTX probably deserves further trials.