病例分析讨论 上海交大医学院附属新华医院肿瘤科 郑磊贞 病例分析讨论 上海交大医学院附属新华医院肿瘤科 郑磊贞

Patient Characteristics 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 LN enlargement :about 2cm 体检：左锁骨上扪及多枚淋巴结，2cm大小

Patient Characteristics 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: 10.69ng/L Stage: cTxNxM1 Stage Ⅳ (WHO2000) 临床分期 CTxNxM1 Stage Ⅳ (WHO2000)

Prior Treatment Reciving LEOF Regimen for palliative treatment 入院后于2005年5月27日起行第一程姑息化疗，LEOF方案（5-FU 2.5 CIV d1-5,LV 0.3 d1-5 ,乐沙定0.2 d1,EPI 70mg d1）,28天为1疗程 Finding left supraclavicular LN disapear after 1st cycle: 第2次入院时锁骨上淋巴结消失 CT Scan: Tumor at primary lesion shrinked obviously and more than 50%, matastasis LN disapear 3疗程后复查CT：原发病灶明显缩小>50%, 颈部淋巴结消失,后腹膜淋巴结消失,纵隔淋巴结消失 Tumor Marker: CA125：正常 CA199: 45.52U/ml CA724: normal

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 Treatment 继续LEOF化疗3疗程 CT Scan: as the same as before Completed LEOF more 3 cycles 继续LEOF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

Adverse Event Adverse Event grade II Sensory Neuropathy grade II Hematological toxicities (e.g., neutropenia)

What shall you do after 6 cycles? Xeloda 1500mg/m2, twice daily, ×14days LEOF(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 cycles? Xeloda 1500mg/m2, twice daily, ×14days LEOF(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% 7.7% 12.8% 25.6%

Actual Treatment Refusing Operation 仍拒绝手术 Patient received Xeloda: 1500mg, twice daily, ×14days every 3 weeks Follow-up: Regularly consultation

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

What’s your Next Choice？ 1. 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 2.7% 2. 5.4% 3. 2.7% 4. 67.6% 5. 21.6%

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