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1、Patient T,Female,45 years old 胡某,女，45岁The gastroscope and biopsy before surgery:gastric sinus adenocarcinoma 术前胃镜及活检证实胃窦部腺癌Sep.2004 received radical resection of gastric cancer 2004年9月接受了胃癌根治术Pathological Report:Ulcerative Adenocarcinoma,low differentiation,invades serosa layer,adherence with adjace
2、nt pancreas,lymph nodes metastasis 12/16 病理报告：低分化溃疡型腺癌，侵犯浆膜层，与胰腺粘连，淋巴结转移灶12/16Stage:T4N2M0，G3,Stage IV 分期IV期，T4N2M0，G3,Patient Characteristics,Completed chemotherapy regimen(MMC+CF+5-FU)4cycles after surgery 手术后完成4个周期(MMC+CF+5-FU)方案的辅助化疗Physical examination at the 6th month after chemotherapy finds
3、the left-supraclavicular lymph nodes(size:2cm).CT Scan:two lymph nodes behind posterior peritoneum involved(size:3cm and 2.5cm)术后6个月复诊时体检发现左侧锁骨上淋巴结肿大，2cm。CT扫描发现腹膜后两个肿大淋巴结，3 cm及2.5cmCA199：305u/L CEA:126ng/ml,Prior Treatment,Whats your Recommend Regimen?,Single agent?1、Xeloda 1250mg/m2,twice daily,14d
4、ays,6 cycles Combination regimens?2、DF(cisplatin+5-FU)3、Xeloda+cisplatin 4、FOLFOX(5-FU/LV+Oxaliplatin)5、Irinotecan-based regimen 6、Taxane-based regimen,0%,0%,10.3%,41.4%,0%,48.3%,Actual Treatment,Patient received Xeloda+cisplatin regimen as first-line chemotherapy Xeloda:1000mg/m2,twice daily,14days
5、 cisplatin:75mg/m2,day1 every 3 weeks Patient complained that the adverse reaction of nause and vomiting of cisplatin was too painful for her to go on with more treatment.Only completed 2 cycles.患者由于顺铂所致的恶心呕吐反应过重，只进行了 两个周期的化疗。,Physical examination:left-supraclavicular lymph nodes(size:1cm).CT Scan:t
6、wo lymph nodes behind posterior peritoneum involved shrink obviously,(size:2cm and 1cm)CA199:102u/L CEA:21ng/mlPartial Response,Actual Response,1、Maintain Xeloda and cisplatin dosage?因原方案有效维持原方案化疗？2、Reduce cisplatin dosage to 75%and continue?将顺铂剂量减为原剂量的75%后继续治疗？3、Interrupt？中断治疗4、Change drug？更换药物,Wha
7、t to do next?,6.3%,40.6%,0%,53.1%,Change drug Patient received XELOX Xeloda:1000mg/m2,twice daily,14days Oxaliplatin:130mg/m2,day1 every 3 weeksCompleted 4 cycles,Actual Treatment,The mild symptoms of erythema and swelling on her hands and feet were be observed after 2 cycles of XELOX.She continued
8、the other 2 cycles of XELOX without dosage reducing or treatment delaying.完成2周期后患者有轻微的手足部痛性红斑及肿胀。但这并没有促使化疗减量或延期。Insensible feeling of hands and feet caused by oxaliplatin also happened.But mild too.奥沙利铂导致的手足麻木感也很轻微。,Adverse Reaction,Physical examination:left-supraclavicular lymph nodes(size:0.5cm).C
9、T Scan:two lymph nodes behind posterior peritoneum involved disappeared,(size:0cm and 0cm)CA199:40u/L CEA:11ng/mlPartial Response,Actual Response,What shall you do after 6 cycles?,Maintain therapy?1、Xeloda 1000mg/m2,twice daily,14daysContinue with XELOX 2、Xeloda+OxaliplatinChange to other regimen?3、
10、T+F(5-FU/LV+Taxane)4、FOLIRI(5-FU/LV+Irinotecan)5、Radiotherapy?6、Observe?,37.5%,21.9%,3.1%,9.4%,6.3%,21.9%,Patient received palliative radiotherapy the left-supraclavicular area:50GY the area of tumor bed:45GY 患者接受了姑息性放疗，左侧锁骨上区域50GY，原瘤床部位45GYConcurrent chemotherapy Xeloda 900mg/m2,twice daily,14days
11、2 cycles 希罗达同步增敏化疗2周期,Actual Treatment,Clinical Efficacy,Physical examination:left-supraclavicular lymph nodes disappeared.CT Scan:two lymph nodes behind posterior peritoneum involved disappearedCA199:12u/L CEA:6ng/mlComplete ResponseLast follow up date:Apr.2006,What shall you do next?,1、Xeloda 1000mg/m2,twice daily,14days2、Xeloda(5FU)+Oxaliplatin3、other regimens 4、Observe?,24.2%,0%,0%,75.8%,
