病例討論(晚期胃癌)課件

1、病例分析討論上海交大醫(yī)學(xué)院附屬新華醫(yī)院腫瘤科病例分析討論上海交大醫(yī)學(xué)院附屬新華醫(yī)院腫瘤科Patient W, Female, 53 years old 王某, 女,53歲Apr. 2005 received endoscopy for abdominal pain 2005年4月因“反復(fù)噯氣、腹脹6年,中上腹痛半年伴消瘦”行胃鏡檢查Pathological Report: Gastric Adenocarcinoma, low differentiated 病理報告:胃竇中度慢性淺表性胃炎,胃底低分化腺癌Physical examination: left supraclavicular LN

2、 enlargement :about 2cm 體檢:左鎖骨上捫及多枚淋巴結(jié),2cm大小Patient CharacteristicsPatient W, Female, 53 years olCT Scan: Multi-lymph nodes behind posterior peritoneum involved 上腹部CT:胃底部及胃體上部癌,腹腔巨大轉(zhuǎn)移淋巴結(jié),并與原發(fā)灶融合,后腹膜淋巴結(jié)轉(zhuǎn)移Tumor Markers 腫瘤標(biāo)記物:CA125:18.84U/ml CA199: 13.75U/ml CA724: 300U/ml CEA: 7.5ng/L AFP: 10.69ng/LSt

3、age: cTxNxM1 Stage (WHO2000) 臨床分期 CTxNxM1 Stage (WHO2000)Patient CharacteristicsCT Scan: Multi-lymph nodes beh病例討論(晚期胃癌)課件病例討論(晚期胃癌)課件Prior TreatmentClinical evaluation: Partial Response 臨床評估:部分緩解 Refusing operation 建議手術(shù),患者拒絕Prior TreatmentClinical evaluaCompleted LEOF more 3 cycles 繼續(xù)LEOF化療3療程CT Sc

4、an: as the same as before 6程化療后復(fù)查CT:與三療程后CT結(jié)果相仿 Tumor Marker: CA125:正常 CA199: 45.52U/ml CA724: normalPrior TreatmentCompleted LEOF more 3 cyclesPr病例討論(晚期胃癌)課件Adverse EventAdverse Event grade II Sensory Neuropathy grade II Hematological toxicities (e.g., neutropenia) Adverse EventAdverse EventWhat sh

5、all you do after 6 cycles?Xeloda 1500mg/m2, twice daily, 14daysLEOF(5-FU/LV+Oxaliplatin+Epi-ADM)TCF(Taxol+CDDP+5-FU)XELOX/ FOLFOX(Xeloda/5-FU/LV+Oxaliplatin)Observe?SurgeryWhat shall you do after 6 cyclWhat shall you do after 6 cycles?Xeloda 1500mg/m2, twice daily, 14daysLEOF(5-FU/LV+Oxaliplatin+Epi

6、-ADM)TCF(Taxol+CDDP+5-FU)XELOX/ FOLFOX(Xeloda/5-FU/LV+Oxaliplatin)Observe?Surgery43.6%0%10.3%12.8%25.6%7.7%What shall you do after 6 cyclActual Treatment Refusing Operation 仍拒絕手術(shù)Patient received Xeloda: 1500mg, twice daily, 14days every 3 weeksFollow-up: Regularly consultationActual Treatment Refusi

7、ng Oper Adverse EventPatient complained that he got painful erythema and swelling on his body at consultation after 3 cycles 完成3周期后門診主訴軀干部皮疹,融合成片,瘙癢明顯CT Scan: posterior peritoneum enlarged again, and progression should be considered 停藥三周后,復(fù)查CT:后腹膜淋巴結(jié)增大,原發(fā)灶穩(wěn)定,臨床考慮進(jìn)展 Adverse EventPatient complain病例討論(

8、晚期胃癌)課件 Whats your Next Choice?Maintain Xeloda dosage, restart XELOX until HFS resolved to Grade 1按原劑量XELODA開始Reduce Xeloda dosage to 750mg/m2 bid將Xeloda劑量減為原劑量的75%后繼續(xù)治療Interrupt中斷治療Change drug 更換藥物Radiotherapy放療1.2.3.4.5.2.7%5.4%2.7%67.6%21.6% Whats your Next Choice?MainActual TreatmentTP (Docetaxel+CDD