病例讨论（晚期胃癌）.ppt

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 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% 12.8% 25.6% 7.