紫杉醇腹腔灌注化疗治疗晚期胃癌合并恶性腹水的临床疗效观察

Clinical effect of paclitaxel peritoneal perfusion chemotherapy in treatment of advanced gastric cancer with malignant ascites

摘要:

目的：观察紫杉醇腹腔灌注联合全身化疗治疗晚期胃癌合并恶性腹腔积液的疗效及安全性。方法：选取晚期胃癌伴恶性腹水患者60例，随机分为紫杉醇组和顺铂组，紫杉醇组30例，顺铂组30例，分别于腹腔积液引流干净后，给予腹腔内灌注紫杉醇或顺铂，灌注3次为1个疗程，2个疗程后评价疗效，2组均同时联合两药方案行全身化疗，分析2组纳入观察病例的临床疗效及安全性。结果：所有患者均可评价：紫杉醇组有效率（response rate，RR）为60.0%，疾病控制率（disease control rate，DCR）为83.3%，中位肿瘤进展时间（time to progress，TTP）为10个月，KPS评分为（78.000±13.235）分；顺铂组RR为40.0%，DCR为73.3%，中位TTP为7个月，KPS评分为（71.000±13.222）分。紫杉醇组的疗效有优于顺铂组的趋势，无统计学差异（Z=-1.245，P=0.213）；2组治疗后TTP以及KPS的改善差异均有统计学意义（χ2=15.864，P=0.000；Z =-2.067，P=0.039）。2组主要不良反应有骨髓抑制、恶心呕吐、腹痛、腹泻、肌肉关节痛、口腔黏膜炎等，症状均较轻，予对症处理可缓解，不影响治疗。未见过敏反应及明显的肝肾功能损害，无治疗相关性死亡（P >0.05）。结论：紫杉醇腹腔灌注化疗治疗合并恶性腹水的晚期胃癌较顺铂组有更好的疗效，且药物毒副作用小，患者耐受性良好，能更好地改善患者生活质量，延长TTP。

Abstract:

Objective：To investigate the clinical effect and safety of paclitaxel peritoneal perfusion combined with systemic chemotherapy in the treatment of advanced gastric cancer with malignant peritoneal effusion. Methods：A total of 60 patients with ad－vanced gastric cancer and malignant ascites were randomly divided into paclitaxel group and cisplatin group，with 30 patients in each group. The patients were given peritoneal perfusion with paclitaxel or cisplatin after peritoneal effusion drainage. Three times of per－fusion was one course of treatment，and the clinical effect was evaluated after two courses. All patients were given systemic chemother－apy with two drugs in addition to peritoneal perfusion，and clinical outcome and safety were evaluated. Results：All patients were avail－able for evaluation. The paclitaxel group had a response rate（RR） of 60.0%，a disease control rate（DCR） of 83.3%，a median time to progress（TTP） of 10 months，and a KPS score of （78.000±13.235） points；the cisplatin group had an RR of 40.0%，a DCR of 73.3%，a median TTP of 7 months，and a KPS score of （71.000±13.222） points. The paclitaxel group tended to have a better clinical out－come than the cisplatin group（Z=-1.245，P=0.213）. There were significant differences between the two groups in the improvements in TTP and KPS after treatment（TTP：χ2=15.864，P=0.000；KPS：Z=-2.067，P=0.039）. Major adverse reactions included bone marrow suppression，nausea and vomiting，abdominal pain，diarrhea，muscle joint pain，and oral mucositis，and the symptoms were mild and were alleviated after symptomatic treatment，which did not affect the treatment. No allergic reaction or marked liver/renal dysfunction was observed，and there were no treatment-related deaths（P>0.05）. Conclusion：Paclitaxel peritoneal per－fusion chemotherapy has a better clinical effect than cisplatin in the treatment of advanced gastric cancer with malignant peritoneal effusion，with fewer toxicities and side effects. Such treatment has good tolerability in patients and can improve quality of life and prolong TTP.