食管癌同步放化疗

1、SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND

2、 AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 我国食管癌我国食管癌 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY S

3、urgical OncologySurgical Oncology Radiation OncologyRadiation Oncology Medical OncologyMedical Oncology Biological and Target TherapyBiological and Target Therapy The traditional Chinese medicineThe traditional Chinese medicine 治疗手段治疗手段 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFIL

4、IATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 局部病变局部病变 肿瘤治愈肿瘤治愈 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XI

5、SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 机制机制 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 机制机制 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE O

6、F XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 一线药物一线药物 （9090年代以前的年代以前的 ）顺铂、顺铂、5 5FuFu、阿霉素、阿霉素 二线药物二线药物 （9090年代以后）年代以后）泰素、泰索蒂、诺维本、健择、泰素、泰索蒂、诺维本、健择、 半合成的喜树碱衍生物、新一代铂类半合成的喜树碱衍生物、新一代铂类 生物靶向药物生物靶向药物 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISE

7、COND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 5Fu 1.抗代谢药抗代谢药 2. 在体内转变为在体内转变为5氟尿嘧啶脱氧核苷氟尿嘧啶脱氧核苷 抑制胸腺嘧啶核甙合成酶

8、，影响抑制胸腺嘧啶核甙合成酶，影响DNA的生物合成的生物合成 3、能掺入、能掺入RNA中干扰蛋白质合成中干扰蛋白质合成 4. 对有氧和乏氧细胞有相同的杀伤作用对有氧和乏氧细胞有相同的杀伤作用 5Fu SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISE

9、COND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 甲酰四氢叶酸甲酰四氢叶酸 顺铂顺铂 加强加强 5 5FuFu 生化调节机制生化调节机制 4 4 用药时间用药时间放疗后放疗后5min5min8h8h 5 5 用药量用药量200200375mg/m375mg/m2 2 5 5FuFu特点：特点： 特点：吸收后在体内逐渐变为氟尿嘧啶而起作用特点：吸收后在体内逐渐变为氟尿嘧啶而起作用 其作用机理与氟尿嘧啶相同，其作用机理与氟尿嘧啶相同， 在体内能干扰、阻断在体内能

10、干扰、阻断DNA、RNA及蛋白及蛋白 质的合成质的合成 其毒性只有氟尿嘧啶的其毒性只有氟尿嘧啶的1/41/7 化疗指数为氟尿嘧啶的化疗指数为氟尿嘧啶的2倍倍 血液中半衰期为血液中半衰期为5h 用药量，一般用药量，一般5001000mg/day 慢性毒性试验中未见到严重的骨髓抑制，对免疫慢性毒性试验中未见到严重的骨髓抑制，对免疫 的影响较为轻微。的影响较为轻微。 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIV

11、ERSITYAN JIAOTONG UNIVERSITY 新一代新一代 替加氟替加氟 Tegafur Injection 特点：特点：不需经过肝脏的药物代谢而释放出不需经过肝脏的药物代谢而释放出5-Fu5-Fu 在血液、淋巴液、腹腔积液以及肿瘤组织中保持在血液、淋巴液、腹腔积液以及肿瘤组织中保持 高浓度。高浓度。 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVER

12、SITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 顺

13、铂顺铂 Cisplatin,PDD，DDP 1 铂的金属络合物，作用似烷化剂铂的金属络合物，作用似烷化剂 2 主要作用靶点为主要作用靶点为DNA 作用于作用于DNA链间及链内交链，形成链间及链内交链，形成DDPDNA复合物复合物 干扰干扰DNA复制，或与核蛋白及胞浆蛋白结合。复制，或与核蛋白及胞浆蛋白结合。 3 属周期非特异性药属周期非特异性药 顺铂的抗肿瘤作用顺铂的抗肿瘤作用 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAO

14、TONG UNIVERSITYAN JIAOTONG UNIVERSITY 浓度依赖性浓度依赖性 时间依赖性时间依赖性 顺铂小剂量长期用药顺铂小剂量长期用药 抑制抑制肿瘤细胞对放疗所致亚致死性损伤肿瘤细胞对放疗所致亚致死性损伤修复修复 抑制抑制和潜在致死性损伤的和潜在致死性损伤的修复修复 顺铂顺铂最低临床应用剂量最低临床应用剂量 6mg/m2/d SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYA

15、N JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 5Fu 顺铂顺铂 二者对放射增敏有协同作用二者对放射增敏有协同作用 增敏效果与给药时间有关增敏效果与给药时间有关 顺铂在放疗前顺铂在放疗前16h 5Fu持续给药持续给药 增敏效果最佳增敏效果最佳 在乏氧的条件下卡铂的增敏作用高于顺铂在乏氧的条件下卡铂的增敏作用高

16、于顺铂 奥沙利铂（乐沙定奥沙利铂（乐沙定, , 草酸铂）草酸铂） L-OHPL-OHP复合体复合体 DDPDDP复合体复合体 靶分子和作用机制不同靶分子和作用机制不同 抗瘤谱不同抗瘤谱不同 萘达铂萘达铂 肾毒性、胃肠道反应及骨髓抑制均较肾毒性、胃肠道反应及骨髓抑制均较DDPDDP轻轻 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFF

17、ILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 泰素、紫素、特素、紫脘素，泰素、紫素、特素、紫脘素，Paclitaxel, Taxol, PTX 机制机制 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAO

18、TONG UNIVERSITYAN JIAOTONG UNIVERSITY 机制机制 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 健择健择 gemcitabine hydrochloride,盐酸盐酸吉西吉西他滨他滨 细胞周期特异性抗代谢类药物细胞周期特异性抗代谢类药物 作用于作用于DNADNA合成期（合成期（S S期）的肿瘤细胞期）的肿瘤细胞 在

19、一定的条件下，可以阻止在一定的条件下，可以阻止G1G1期向期向S S期的进展期的进展 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOT

20、ONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY METHODS. This phase III prospective, randomized, and stratified trial was undertaken to evaluate the efficacy of fou

21、r courses of combined fluorouracil (1000 mg per square meter of body-surface area daily for four days) and cisplatin (75 mg per square meter on the first day) plus 5000 cGy of radiation therapy, as compared with 6400 cGy of radiation therapy alone, in patients with squamous-cell carcinoma or adenoca

22、rcinoma of the thoracic esophagus. RESULTS. The median survival was 8.9 months in the radiation-treated patients, as compared with 12.5 months in the patients treated with chemotherapy and radiation therapy. In the former group, the survival rates at 12 and 24 months were 33 percent and 10 percent,

23、respectively, whereas they were 50 percent and 38 percent in the patients receiving combined therapy (P less than 0.001). Seven patients in the radiotherapy group and 25 in the combined-therapy group were alive at the time of the analysis. SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AF

24、FILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 1级级NCCN SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND

25、AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILI

26、ATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED H

27、OSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITA

28、L OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF M

29、EDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY Yamada K, MurakamiM,Okamoto Y, et al. Treatment results of chemoradiotherapy for clinica

30、l stage I ( T1N0M0) esophageal carcinoma J . Int J Radiat Oncol Biol Phys, 2006, 64 ( 4 ) : 1106- 1111. SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 第第49届届ASTRO年会报道年会报道(三三)食管癌放疗进展食管癌放疗进展 北京医院放疗科 高鸿

31、李高峰 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 2B

32、 2B2B级是基于低水平证据，专家组无统一认识，但争议不大级是基于低水平证据，专家组无统一认识，但争议不大 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY / SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSP

33、ITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL O

34、F MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDI

35、CAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY ，Bevacizumab 羟羟(基基)脲脲奈达铂奈达铂 奥沙利铂奥沙利铂 依立替康依立替康多西他赛多西他赛紫杉醇紫杉醇,红杉醇红杉醇 表柔比星表柔比星卡培他滨卡培他滨 SECOND

36、AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 以上以上20多项临床试验，涉及以上的药物多项临床试验，涉及以上的药物 以及以及3DCRT，分段放疗，分段放疗，后程加速超分割等放疗方法。后程加速超分割等放疗方法。 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL

37、OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 2B J Clin Oncol. 2003 Aug 1;21(15):2926-32. Phase I trial of escalating-dose irinotecan given weekly with cisplatin and concurrent radiotherapy in locally advanced esophageal cancer. SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF

38、 XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY Int J Radiat Oncol Biol Phys. 2005 May 1;62(1):91-6. P

39、hase I trial of oxaliplatin in combination with cisplatin, protacted-infusion fluorouracil, and radiotherapy in advanced esophageal and gastroesophageal carcinoma. docetaxel (levels 1, 2, 3, 2.5: 20, 30, 40, 35 mg/m(2) cisplatin (40 mg/m(2) on days 1, 15, 29, and 43 5-fluorouracil (400mg/m(2)/day) o

40、n days 1-5, 15-19, 29-33, and 43-47. continuous infusion 61.2 Gy/34 fractions/7 weeks of concurrent radiotherapy. RESULTS: Therefore, level 2.5：35 mg/m(2) was recommended for phase II studies. This regimen was tolerable and highly active. SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFF

41、ILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATE

42、D HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 学者学者方法方法时间时间例数例数用药用药生存率生存率 1 1年年3 3年年5 5年年 刘劲松刘劲松常规同步常规同步2001200140405 Fu、DDP、HCPT75 %42 .5 % 单放单放40405 7.5 %2 0 % 赵献光赵献光常规同步常规同步2002200235355 Fu、PDD74.3%34.3% 单放单放333348.5 %2 1.2 % 季斌季斌常规同步常规同步200220023939盖诺盖诺2530mg/m2,

43、d1,d5 ;顺顺 铂铂 2530mg/m2 ,dl,d2,2 4cycle 季斌季斌常规同步常规同步2002200282825 5-FUFU 500mg/m2，d1-,5d ;顺铂顺铂 60mg/m2,d1;平阳霉素平阳霉素 8mg/次次, dl,d3，3cycle 22.0 % 单放单放808013.8% SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSI

44、TY 学者学者方法方法时间时间例数例数用药用药生存率生存率 1 1年年3 3年年5 5年年 陈俊强陈俊强后程同步后程同步20032003404077.4%77.4% 单放单放404055.1%55.1% 陈友山陈友山常规同步常规同步200520057272DFDF77.8%77.8%44.4%44.4% 单放单放707052.9%52.9%24.3%24.3% 朱振胜朱振胜后程同步后程同步200620063838顺铂顺铂20mg,d120mg,d1d5,d28d5,d28d32,d32, 放疗放疗卡莫氟卡莫氟(HCFU)200mg/(HCFU)200mg/ 次次,3,3次次/d,/d,全程全程

45、 73.7%73.7% 单纯后程单纯后程343455.9%,55.9%, 赵快乐赵快乐后程同步后程同步200620065454顺铂顺铂25mg/m2d1-d3,25mg/m2d1-d3,氟尿嘧氟尿嘧 啶啶600mg/ m2, d1-600mg/ m2, d1- d3,4cycled3,4cycle 67%67%44%44%40%,40%, 单纯后程单纯后程 5757 77%77%39%39%28%,28%, SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLE

46、GE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 学者学者方法方法时间时间例数例数用药用药生存率生存率 1 1年年3 3年年5 5年年 高丽莉高丽莉3DCRT +3DCRT +化化 疗疗 2008200846465 5- -FU 500mg/mFU 500mg/m2 2 + DDP + DDP 20mg/m20mg/m2 2 , , d1-d5,4- d1-d5,4- 6cycle6cycle 7979. .8%8%5050. .1%1% 3DCRT3DCRT44446969. .2%2%3838. .0%0% 陈伟陈伟常规同步常规同步2

47、00820083030NVB NVB 30mg/m30mg/m2, 2,d1,d8 + d1,d8 +DDP DDP 20mg/m20mg/m2 2 , , d1-d5, d1-d5, 2cycle2cycle 7676. .6%6%4040. .0%0% 单放单放32324242. .0%0%1818. .0%0% 李国忠李国忠常规同步常规同步200720078888多西他赛多西他赛20mg/w20mg/w8989. .8%8%3939. .7%7% 王惠王惠常规同步常规同步200820083333PTXPTX 60mg/w 60mg/w8484. .6%6% 单放单放22226060. .

48、6%6% SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY S

49、ECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XISECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYAN JIAOTONG UNIVERSITY 机制机制 特点：吸收后在体内逐渐变为氟尿嘧啶而起作用特点：吸收后在体内逐渐变为氟尿嘧啶而起作用 其作用机理与氟尿嘧啶相同，其作用机理与氟尿嘧啶相同， 在体内能干扰、阻断在体内能干扰、阻断DNA、RNA及蛋白及蛋白 质的合成质的合成 其毒性只有氟尿嘧啶的其毒性只有氟尿嘧啶的1/41/7 化疗指数为氟尿嘧啶的化疗指数为氟尿嘧啶的2倍倍 血液中半衰期为血液中半衰期为5h 用药量，一般用药量，一般5001000mg/day 慢性毒性试验中未