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

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1 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

2 Patient Characteristics
Patient W, Female, 53 years old 王某, 女，53岁 Apr 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

3 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)

4 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

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6 Prior Treatment Clinical evaluation: Partial Response 临床评估：部分缓解
Refusing operation 建议手术,患者拒绝

7 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

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

10 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

11 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%

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

13 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

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15 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%

16 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