病例分析讨论
上海交大医学院附属新华医院肿瘤科
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
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)
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
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
将Xeloda剂量减为原剂量的75%后继续治疗
5.4%
3.
Interrupt
中断治疗
2.7%
4. Change drug
更换药物Biblioteka 67.6%5.Radiotherapy
放疗
21.6%
Actual Treatment
TP (Docetaxel+CDDP)2 cycles/3 weeks
TP (泰素帝85mg/m2+顺铂)/3周重复
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
5. Observe? 6. Surgery
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
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
2.7%
2. Reduce Xeloda dosage to 750mg/m2 bid
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)
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
What shall you do after 6 cycles?
1. Xeloda 1500mg/m2, twice daily, ×14days 2. LEOF(5-FU/LV+Oxaliplatin+Epi-ADM) 3. TCF(Taxol+CDDP+5-FU) 4. XELOX/ FOLFOX(Xeloda/5-FU/LV+Oxaliplatin) 5. Observe? 6. Surgery
What shall you do after 6 cycles?
1. Xeloda 1500mg/m2, twice daily, ×14days
43.6%
2. LEOF(5-FU/LV+Oxaliplatin+Epi-ADM)
3. TCF(Taxol+CDDP+5-FU)
0% 10.3%
4. XELOX/ FOLFOX(Xeloda/5-FU/LV+Oxaliplatin)
Relieve symptoms
症状改善
Still waiting for evaluation
等待评估