胃癌 MDT-梁军.ppt

* * Conclusions: Adjuvant chemotherapy with S-1 for gastric cancer is feasible and effective. This regimen can be the standard treatment for stage II/III gastric cancer pts after curative D2 dissection. 一种新型口服氟尿嘧啶类药物: Tegafur (5FU前体药物) Gimeracil (通过抑制 DPD酶阻断5FU降解) 吉美嘧啶 Oteracil (Oxo乳清酸磷酸核糖转移酶的竞争性抑制剂使5FU的胃肠道毒性减小) 奥替拉西 ORR of 26-49% in various phase II trials in gastric cancer1 * Figure 1. Kaplan-Meier Estimates of Overall Survival and Relapse-free Survival. Three years after randomization, the rate of overall survival was 80.1% in the S-1 group and 70.1% in the surgery-only group (Panel A), and the rate of relapse-free survival was 72.2% in the S-1 group and 59.6% in the surgery-only group (Panel B). The hazard ratio for death in the S-1 group as compared with the surgery-only group was 0.68 (95% confidence interval, 0.52 to 0.87; P=0.003). The hazard ratio for relapse in the S-1 group was 0.62 (95% confidence interval, 0.50 to 0.77; P﹤0.001) * ARTIST study design. Lee et al. ASCO GI 2009 * In conclusion: XP was tolerable in the post-operative setting. The addition of radiotherapy to adjuvant XP chemotherapy did not significantly increase toxicity. The majority of patients completed the planned post-operative treatment. The results on disease-free survival will be available in 2011. Lee et al. ASCO GI 2009 Sun et al Br J Surg 2009 胃癌术后辅助治疗的Meta分析 胃癌术后S1 单药辅助化疗— III期临床随机对照研究（ACTS-GC，日本） 1059 例 (stage II/III ，D2) 随访3年 S-1 单药组 529 cases OS:80.1% OS:70.1% 单纯手术组 530 cases 备注：S-1治疗12个月， 80 mg/m2/d x 4 周, 休息2周；78%的病例完成 了6个月治疗，71%完成了12个月 3/4度毒性反应少见 (恶心、腹泻3-4%) 50%分期II期，40% III期 45% T3-4，90% N+ Sakuramoto S et al. N Engl J Med 2007;357:1810-1820 新型口服氟尿嘧啶类药物: ·Tegafur (5FU前体药物) ·吉美嘧啶 ·奥替拉西 三药复合制剂 首次证实对D2切除术后辅助化疗有意义 无复发生存率(RFS) Sakuramoto S et al. N Engl J Med 2007;357:1810-1820 72.2% 59.6% 多学科治疗 胃癌 术前化疗 手术 术前放化疗 手术 食管-胃交界肿瘤 手术 术后放化疗 手术 术后化疗 胃癌术后辅助放化疗Intergroup 0116 (11年随访结果更新) 0% 20% 40% 60% 80% 100% 0 24 48 72 96 120 144