改良FOLFOX方案治疗晚期大肠癌24例临床观察.docVIP

改良FOLFOX方案治疗晚期大肠癌24例临床观察【摘要】 目的 观察改良的FOLFOX方案治疗晚期大肠癌的临床疗效和毒副反应。方法 对24例晚期大肠癌患者，用奥沙利铂(L?OHP) 85 mg/m??2?静脉滴注3 h，亚叶酸钙(CF)400 mg静脉滴注2 h，5?氟尿嘧啶(5?Fu) 500 mg 在CF 滴完后静冲，其后再予5?Fu 2800 mg/m??2?深静脉连续滴注48h，每2周重复给药，治疗4周期后评价疗效。结果 24例中，CR 1 例，PR 8 例，SD 11例，PD 4例，总有效率(CR + PR) 为37.5 %。主要毒副作用是外周神经毒性、恶心呕吐、骨髓抑制。结论 改良FOLFOX 方案治疗晚期大肠癌疗效确切,毒副反应可耐受，值得推广使用。? 【关键词】 晚期大肠癌;联合化学治疗；毒副作用 ?? Clinical study of L?OHP and 5?Fu/CF in the treatment of 24 cases with advanced colorectal Cancer LI li， LIN Zhong，LV Wei?zhe. Department of Oncology, The FifthAffiliated Hospital of Sun Yat?sen University,Zhuhai 519000,China ? 【Abstract】 Objective To evaluate the efficacy and toxicity of our modified FOLFOX regimen in advanced colorectal cancer(ACRC). Methods 24 patients with advanced colorectal cancer were treated with L?OHP plus 5?Fu/CF. L?OHP 85 mg/m??2? iv infusion for 3 hours d1, CF 400 mg in infusion for 2 hours followed by 5?Fu 500 mg iv after the ending of CF,the last 5?Fu 2800 mg/m??2? continuous intravenous infusion for 48 hours. Repeated the regimen every 2 weeks. The effect was evaluated after 4 regimens.Results Among the total 24 cases,1 were CR,PR in 8,SD in 11,PD in 4. The total rate of effectiveness (CR + PR)was 37.5 %. The major side effects were neurotoxicity,nausea and vomiting and myelosuppression.Conclusion This regimen is effective and well?tolerated on advanced colorectal cancer.It is worth of clinical application.? 【Key words】 Advanced colorectal cancer；Combined chemotherapy;Toxicity ? 作者单位：519000中山大学附属第五医院肿瘤科? 通讯作者：林忠 ? ? 模型组相应节段脊髓胶质细胞活化。在CP/CPPS模型大鼠中脊髓小胶质细胞的激活早于脊髓星形胶质细胞，并持续整个试验观察期。我们由此推测，脊髓小胶质细胞在神经病理性疼痛的早期起始阶段起着至关重要的作用，在神经病理性疼痛的持续过程中，不仅是星形胶质细胞的活化，而且脊髓小胶质细胞的活化都是必须的。抑制脊髓星形胶质细胞和小胶质细胞的活性能否阻止或逆转CP/CPPS疼痛还需要进一步研究。? 本研究还发现激活的胶质细胞增加前炎性因子的释放，而前炎性因子与病理性疼痛密不可分2］。前炎性因子致痛机制包括：①直接兴奋感觉神经。②促进长时程增强的形成，引起中枢和外周神经敏感化。③促进前列腺素E?2、白三烯、缓激肽、P物质、兴奋性氨基酸等致痛物质的释放，并与缓激肽、P物质之间形成正反馈。④促进去甲肾上腺素的释放等。有许多学者报道，在炎性和病理性疼痛中，脊髓前炎性因子的水平是上调的3］，鞘内注射外源性的前炎性因子增强伤害性感受4］。相反的，给予IL?