病例讨论(晚期胃癌)课件.ppt

1、上海交大医学院附属新华医院肿瘤科Patient W,Female,53 years old 王某王某,女女,53岁岁Apr.2005 received endoscopy for abdominal pain 2005年年4月因月因“反复嗳气、腹胀反复嗳气、腹胀6年年,中上腹痛半年伴消中上腹痛半年伴消瘦瘦”行胃镜检查行胃镜检查Pathological Report:Gastric Adenocarcinoma,low differentiated 病理报告病理报告:胃窦中度慢性浅表性胃炎胃窦中度慢性浅表性胃炎,胃底低分化腺癌胃底低分化腺癌Physical examination:left su

2、praclavicular LN enlargement:about 2cm 体检体检:左锁骨上扪及多枚淋巴结左锁骨上扪及多枚淋巴结,2cm大小大小Patient CharacteristicsCT Scan:Multi-lymph nodes behind posterior peritoneum involved 上腹部上腹部CT:胃底部及胃体上部癌胃底部及胃体上部癌,腹腔巨大转移淋巴结腹腔巨大转移淋巴结,并与并与原发灶融合原发灶融合,后腹膜淋巴结转移后腹膜淋巴结转移Tumor Markers 肿瘤标记物肿瘤标记物:CA125:18.84U/ml CA199:13.75U/ml CA724

3、:300U/ml CEA:7.5ng/L AFP:10.69ng/LStage:cTxNxM1 Stage (WHO2000)临床分期临床分期 CTxNxM1 Stage (WHO2000)Patient CharacteristicsPrior TreatmentClinical evaluation:Partial Response 临床评估临床评估:部分缓解部分缓解 Refusing operation 建议手术建议手术,患者拒绝患者拒绝Completed LEOF more 3 cycles 继续继续LEOF化疗化疗3疗程疗程CT Scan:as the same as before

4、6程化疗后复查程化疗后复查CT:与三疗程后与三疗程后CT结果相仿结果相仿 Tumor Marker:CA125:正常正常 CA199:45.52U/ml CA724:normalPrior TreatmentAdverse EventAdverse Event grade II Sensory Neuropathy grade II Hematological toxicities(e.g.,neutropenia)What shall you do after 6 cycles?1.Xeloda 1500mg/m2,twice daily,14days2.LEOF(5-FU/LV+Oxali

5、platin+Epi-ADM)3.TCF(Taxol+CDDP+5-FU)4.XELOX/FOLFOX(Xeloda/5-FU/LV+Oxaliplatin)5.Observe?6.SurgeryWhat shall you do after 6 cycles?1.Xeloda 1500mg/m2,twice daily,14days2.LEOF(5-FU/LV+Oxaliplatin+Epi-ADM)3.TCF(Taxol+CDDP+5-FU)4.XELOX/FOLFOX(Xeloda/5-FU/LV+Oxaliplatin)5.Observe?6.Surgery43.6%0%10.3%12

6、.8%25.6%7.7%Actual Treatment Refusing Operation 仍拒绝手术仍拒绝手术Patient received Xeloda:1500mg,twice daily,14days every 3 weeksFollow-up:Regularly consultation Adverse EventPatient complained that he got painful erythema and swelling on his body at consultation after 3 cycles 完成完成3周期后门诊主诉躯干部皮疹周期后门诊主诉躯干部皮疹

7、,融合成片融合成片,瘙痒明显瘙痒明显CT Scan:posterior peritoneum enlarged again,and progression should be considered 停药三周后停药三周后,复查复查CT:后腹膜淋巴结增大后腹膜淋巴结增大,原发灶稳定原发灶稳定,临床临床考虑进展考虑进展 Whats your Next Choice?Maintain Xeloda dosage,restart XELOX until HFS resolved to Grade 1按原剂量按原剂量XELODA开始开始Reduce Xeloda dosage to 750mg/m2 bid将将Xeloda剂量减为原剂量的剂量减为原剂量的75%后继续治疗后继续治疗Interrupt中断治疗中断治疗Change drug 更换药物更换药物Radiotherapy放疗放疗1.2.3.4.5.2.7%5.4%2.7%67.6%21.6%Actual TreatmentTP(Docetaxel+CDDP)2 cycles/3 weeks TP(泰素帝泰素帝85mg/m2+顺铂顺铂)/3周重复周重复Relieve symptoms 症状改善症状改善Still waiting for evaluation 等待评估等待评估