《病例讨论(晚期胃癌)课件.ppt》由会员分享，可在线阅读，更多相关《病例讨论(晚期胃癌)课件.ppt（16页珍藏版）》请在三一办公上搜索。
1、病例分析讨论上海交大医学院附属新华医院肿瘤科,病例分析讨论上海交大医学院附属新华医院肿瘤科,Patient W, Female, 53 years old 王某, 女,53岁Apr. 2005 received endoscopy for abdominal pain 2005年4月因“反复嗳气、腹胀6年,中上腹痛半年伴消瘦”行胃镜检查Pathological Report: Gastric Adenocarcinoma, low differentiated 病理报告:胃窦中度慢性浅表性胃炎,胃底低分化腺癌Physical examination: left supraclavicular
2、LN enlargement :about 2cm 体检:左锁骨上扪及多枚淋巴结,2cm大小,Patient Characteristics,Patient W, Female, 53 years ol,CT Scan: Multi-lymph nodes behind posterior peritoneum involved 上腹部CT:胃底部及胃体上部癌,腹腔巨大转移淋巴结,并与原发灶融合,后腹膜淋巴结转移Tumor Markers 肿瘤标记物:CA125:18.84U/ml CA199: 13.75U/ml CA724: 300U/ml CEA: 7.5ng/L AFP: 10.69n
3、g/LStage: cTxNxM1 Stage (WHO2000) 临床分期 CTxNxM1 Stage (WHO2000),Patient Characteristics,CT Scan: Multi-lymph nodes beh,病例讨论(晚期胃癌)课件,病例讨论(晚期胃癌)课件,Prior Treatment,Clinical evaluation: Partial Response 临床评估:部分缓解 Refusing operation 建议手术,患者拒绝,Prior TreatmentClinical evalua,Completed LEOF more 3 cycles 继续L
4、EOF化疗3疗程CT Scan: as the same as before 6程化疗后复查CT:与三疗程后CT结果相仿 Tumor Marker: CA125:正常 CA199: 45.52U/ml CA724: normal,Prior Treatment,Completed LEOF more 3 cyclesPr,病例讨论(晚期胃癌)课件,Adverse Event,Adverse Event grade II Sensory Neuropathy grade II Hematological toxicities (e.g., neutropenia),Adverse EventAd
5、verse Event,What shall you do after 6 cycles?,Xeloda 1500mg/m2, twice daily, 14daysLEOF(5-FU/LV+Oxaliplatin+Epi-ADM)TCF(Taxol+CDDP+5-FU)XELOX/ FOLFOX(Xeloda/5-FU/LV+Oxaliplatin)Observe?Surgery,What shall you do after 6 cycl,What shall you do after 6 cycles?,Xeloda 1500mg/m2, twice daily, 14daysLEOF(
6、5-FU/LV+Oxaliplatin+Epi-ADM)TCF(Taxol+CDDP+5-FU)XELOX/ FOLFOX(Xeloda/5-FU/LV+Oxaliplatin)Observe?Surgery,43.6%,0%,10.3%,12.8%,25.6%,7.7%,What shall you do after 6 cycl,Actual Treatment,Refusing Operation 仍拒绝手术Patient received Xeloda: 1500mg, twice daily, 14days every 3 weeksFollow-up: Regularly cons
7、ultation,Actual Treatment Refusing Oper,Adverse Event,Patient complained that he got painful erythema and swelling on his body at consultation after 3 cycles 完成3周期后门诊主诉躯干部皮疹,融合成片,瘙痒明显CT Scan: posterior peritoneum enlarged again, and progression should be considered 停药三周后,复查CT:后腹膜淋巴结增大,原发灶稳定,临床考虑进展,A
8、dverse EventPatient complain,病例讨论(晚期胃癌)课件,Whats your Next Choice?,Maintain Xeloda dosage, restart XELOX until HFS resolved to Grade 1按原剂量XELODA开始Reduce Xeloda dosage to 750mg/m2 bid将Xeloda剂量减为原剂量的75%后继续治疗Interrupt中断治疗Change drug 更换药物Radiotherapy放疗,1.,2.,3.,4.,5.,2.7%,5.4%,2.7%,67.6%,21.6%,Whats your Next Choice?Main,Actual Treatment,TP (Docetaxel+CDDP)2 cycles/3 weeks TP (泰素帝85mg/m2+顺铂)/3周重复Relieve symptoms 症状改善Still waiting for evaluation 等待评估,Actual TreatmentTP (Docetaxel+,
