术前胃镜及活检证实胃窦部腺癌【】课件

PatientT,Female,45yearsold

胡某,女，45岁Thegastroscopeandbiopsybeforesurgery:gastricsinusadenocarcinoma

术前胃镜及活检证实胃窦部腺癌Sep.2004receivedradicalresectionofgastriccancer

2004年9月接受了胃癌根治术PathologicalReport:UlcerativeAdenocarcinoma,lowdifferentiation,invadesserosalayer,adherencewithadjacentpancreas,lymphnodesmetastasis12/16

病理报告：低分化溃疡型腺癌，侵犯浆膜层，与胰腺粘连，淋巴结转移灶12/16Stage:T4N2M0，G3,StageIV分期IV期，T4N2M0，G3PatientCharacteristicsPatientT,Female,45yearsolCompletedchemotherapyregimen(MMC+CF+5-FU)×4cyclesaftersurgery

手术后完成4个周期(MMC+CF+5-FU)方案的辅助化疗Physicalexaminationatthe6thmonthafterchemotherapyfindstheleft-supraclavicularlymphnodes(size:2cm).CTScan:twolymphnodesbehindposteriorperitoneuminvolved(size:3cmand2.5cm)术后6个月复诊时体检发现左侧锁骨上淋巴结肿大，2cm。CT扫描发现腹膜后两个肿大淋巴结，3cm及2.5cmCA199：305u/LCEA:126ng/mlPriorTreatmentCompletedchemotherapyregimenWhat’syourRecommendRegimen?Singleagent?1、Xeloda1250mg/m2,twicedaily,×14days,6cycles

Combinationregimens?2、DF(cisplatin+5-FU)3、Xeloda+cisplatin4、FOLFOX(5-FU/LV+Oxaliplatin) 5、Irinotecan-basedregimen6、Taxane-basedregimen0%0%10.3%41.4%0%48.3%What’syourRecommendRegimen?ActualTreatmentPatientreceivedXeloda+cisplatinregimenasfirst-linechemotherapyXeloda:1000mg/m2,twicedaily,×14dayscisplatin:75mg/m2,day1every3weeks

Patientcomplainedthattheadversereactionofnauseandvomitingofcisplatinwastoopainfulforhertogoonwithmoretreatment.Onlycompleted2cycles.

患者由于顺铂所致的恶心呕吐反应过重，只进行了两个周期的化疗。ActualTreatmentPatientrecePhysicalexamination:left-supraclavicularlymphnodes(size:1cm).CTScan:twolymphnodesbehindposteriorperitoneuminvolvedshrinkobviously,(size:2cmand1cm)CA199:102u/LCEA:21ng/mlPartialResponseActualResponsePhysicalexamination:left-sup1、MaintainXelodaandcisplatindosage?因原方案有效维持原方案化疗？2、Reducecisplatindosageto75%

andcontinue?将顺铂剂量减为原剂量的75%后继续治疗？3、Interrupt？中断治疗4、Changedrug？更换药物Whattodonext?6.3%40.6%0%53.1%1、MaintainXelodaandcisplatChangedrugPatientreceivedXELOXXeloda:1000mg/m2,twicedaily,×14daysOxaliplatin:130mg/m2,day1every3weeksCompleted4cyclesActualTreatmentChangedrugActualTreatmentThemildsymptomsoferythemaandswellingonherhandsandfeetwerebeobservedafter2cyclesofXELOX.Shecontinuedtheother2cyclesofXELOXwithoutdosagereducingortreatmentdelaying.完成2周期后患者有轻微的手足部痛性红斑及肿胀。但这并没有促使化疗减量或延期。Insensiblefeelingofhandsandfeetcausedbyoxaliplatinalsohappened.Butmildtoo.

奥沙利铂导致的手足麻木感也很轻微。

AdverseReactionThemildsymptomsoferythemaPhysicalexamination:left-supraclavicularlymphnodes(size:0.5cm).CTScan:twolymphnodesbehindposteriorperitoneuminvolveddisappeared,(size:0cmand0cm)CA199:40u/LCEA:11ng/mlPartialResponseActualResponsePhysicalexamination:left-supWhatshallyoudoafter6cycles?Maintaintherapy?1、Xeloda1000mg/m2,twicedaily,×14daysContinuewithXELOX

2、Xeloda+OxaliplatinChangetootherregimen?3、T+F(5-FU/LV+Taxane)4、FOLIRI(5-FU/LV+Irinotecan)5、Radiotherapy?6、Observe?37.5%21.9%3.1%9.4%6.3%21.9%Whatshallyoudoafter6cyclPatientreceivedpalliativeradiotherapytheleft-supraclaviculararea:50GYtheareaoftumorbed:45GY

患者接受了姑息性放疗，左侧锁骨上区域50GY，原瘤床部位45GYConcurrentchemotherapyXeloda900mg/m2,twicedaily,×14days2cycles

希罗达同步增敏化疗2周期ActualTreatmentPatientreceivedpalliativeraClinicalEfficacyPhysicalexamination:left-supraclavicularlymphnodesdisappeared.CTScan:twolymphnodesbehindposteriorperitoneuminvolveddisappearedCA199:12u/LCEA:6ng/mlCompleteResponseLastfollowupdate:Apr.2006ClinicalEfficacyPhysicalexamWhatshallyoudonext?1、Xeloda1000mg/m2,twicedaily,×14days2、Xeloda(5FU)+Oxaliplatin3、otherregimens

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胡某,女，45岁Thegastroscopeandbiopsybeforesurgery:gastricsinusadenocarcinoma

术前胃镜及活检证实胃窦部腺癌Sep.2004receivedradicalresectionofgastriccancer

2004年9月接受了胃癌根治术PathologicalReport:UlcerativeAdenocarcinoma,lowdifferentiation,invadesserosalayer,adherencewithadjacentpancreas,lymphnodesmetastasis12/16

病理报告：低分化溃疡型腺癌，侵犯浆膜层，与胰腺粘连，淋巴结转移灶12/16Stage:T4N2M0，G3,StageIV分期IV期，T4N2M0，G3PatientCharacteristicsPatientT,Female,45yearsolCompletedchemotherapyregimen(MMC+CF+5-FU)×4cyclesaftersurgery

手术后完成4个周期(MMC+CF+5-FU)方案的辅助化疗Physicalexaminationatthe6thmonthafterchemotherapyfindstheleft-supraclavicularlymphnodes(size:2cm).CTScan:twolymphnodesbehindposteriorperitoneuminvolved(size:3cmand2.5cm)术后6个月复诊时体检发现左侧锁骨上淋巴结肿大，2cm。CT扫描发现腹膜后两个肿大淋巴结，3cm及2.5cmCA199：305u/LCEA:126ng/mlPriorTreatmentCompletedchemotherapyregimenWhat’syourRecommendRegimen?Singleagent?1、Xeloda1250mg/m2,twicedaily,×14days,6cycles

Combinationregimens?2、DF(cisplatin+5-FU)3、Xeloda+cisplatin4、FOLFOX(5-FU/LV+Oxaliplatin) 5、Irinotecan-basedregimen6、Taxane-basedregimen0%0%10.3%41.4%0%48.3%What’syourRecommendRegimen?ActualTreatmentPatientreceivedXeloda+cisplatinregimenasfirst-linechemotherapyXeloda:1000mg/m2,twicedaily,×14dayscisplatin:75mg/m2,day1every3weeks

Patientcomplainedthattheadversereactionofnauseandvomitingofcisplatinwastoopainfulforhertogoonwithmoretreatment.Onlycompleted2cycles.

患者由于顺铂所致的恶心呕吐反应过重，只进行了两个周期的化疗。ActualTreatmentPatientrecePhysicalexamination:left-supraclavicularlymphnodes(size:1cm).CTScan:twolymphnodesbehindposteriorperitoneuminvolvedshrinkobviously,(size:2cmand1cm)CA199:102u/LCEA:21ng/mlPartialResponseActualResponsePhysicalexamination:left-sup1、MaintainXelodaandcisplatindosage?因原方案有效维持原方案化疗？2、Reducecisplatindosageto75%

andcontinue?将顺铂剂量减为原剂量的75%后继续治疗？3、Interrupt？中断治疗4、Changedrug？更换药物Whattodonext?6.3%40.6%0%53.1%1、MaintainXelodaandcisplatChangedrugPatientreceivedXELOXXeloda:1000mg/m2,twicedaily,×14daysOxaliplatin:130mg/m2,day1every3weeksCompleted4cyclesActualTreatmentChangedrugActualTreatmentThemildsymptomsoferythemaandswellingonherhandsandfeetwerebeobservedafter2cyclesofXELOX.Shecontinuedtheother2cyclesofXELOXwithoutdosagereducingortreatmentdelaying.完成2周期后患者有轻微的手足部痛性红斑及肿胀。但这并没有促使化疗减量或延期。Insensiblefeelingofhandsandfeetcausedbyoxaliplatinalsohappened.Butmildtoo.

奥沙利铂导致的手足麻木感也很轻微。

AdverseReactionThemildsymptomsoferythemaPhysicalexamination:left-supraclavicularlymphnodes(size:0.5cm).CTScan:twolymphnodesbehindposteriorperitoneuminvolveddisappeared,(size:0cmand0cm)CA199:40u/LCEA:11ng/mlPartialResponseActualResponsePhysicalexamination:left-supWhatshallyoudoafter6cycles?Maintaintherapy?1、Xeloda1000mg/m2,twicedaily,×14daysContinuewithXELOX

2、Xeloda+OxaliplatinChangetootherregimen?3、T+F(5-FU/LV+Taxane)4、FOLIRI(5-FU/LV+Irinotecan)5、Radiotherapy?6、Observe?37.5%21.9%3.1%9.4%6.3%21.9%Whatshallyoudoafter6cyclPatientreceivedpalliativeradiotherapytheleft-supraclaviculararea:50GYtheareaoftumorbed:45GY

患者接受了姑息性放疗，左侧锁骨上区域50GY，原瘤床部位45GYConcurrentchemotherapyXeloda900mg/m2,twicedaily,×14days2cycles

希罗达同步增敏化疗2周期ActualTreatmentPatientreceivedpalliativeraClinicalEfficacyPhysicalexamination:left-supraclavicularlymphnodesdisappeared.CTScan:twolymphnodesbehindposteriorperitoneuminvolveddisappearedCA199:12u/LCEA:6ng/mlCompleteResponseLastfollowupdate:Apr.2006ClinicalEfficacyPhysicalexamWhatshallyoudonext?1、Xeloda1000mg/m2,twicedaily,×14days2、Xeloda(5FU)+Oxaliplatin3、otherregimens

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