病例讨论(晚期胃癌)课件

Click to edit Master title style Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,病例分析讨论,上海交大医学院附属新华医院肿瘤科,病例分析讨论上海交大医学院附属新华医院肿瘤科,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,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,体检:左锁骨上扪及多枚淋巴结,2cm大小,Patient Characteristics,Patient W,Female,53 years ol,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,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 (WHO2000),临床分期 CTxNxM1 Stage (WHO2000),Patient Characteristics,CT Scan:Multi-lymph nodes beh,病例讨论(晚期胃癌)课件,病例讨论(晚期胃癌)课件,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 TreatmentClinical evalua,Completed LEOF more 3 cycles,继续LEOF化疗3疗程,CT Scan:as the same as before,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,Prior Treatment,Completed LEOF more 3 cyclesPr,病例讨论(晚期胃癌)课件,Adverse Event,Adverse Event,grade II Sensory Neuropathy,grade II Hematological toxicities(e.g.,neutropenia),Adverse EventAdverse Event,What shall you do after 6 cycles?,Xeloda 1500mg/m,2,twice daily,14days,LEOF(5-FU/LV+Oxaliplatin+Epi-ADM),TCF(Taxol+CDDP+5-FU),XELOX/FOLFOX(Xeloda/5-FU/LV+Oxaliplatin),Observe?,Surgery,What shall you do after 6 cycl,What shall you do after 6 cycles?,Xeloda 1500mg/m,2,twice daily,14days,LEOF(5-FU/LV+Oxaliplatin+Epi-ADM),TCF(Taxol+CDDP+5-FU),XELOX/FOLFOX(Xeloda/5-FU/LV+Oxaliplatin),Observe?,Surgery,43.6%,0%,10.3%,12.8%,25.6%,7.7%,What shall you do after 6 cycl,Actual Treatment,Refusing Operation,仍拒绝手术,Patient received,Xeloda:1500mg,twice daily,14days,every 3 weeks,Follow-up:Regularly consultation,Actual Treatment Refusing Oper,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,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,Adverse EventPatient complain,病例讨论(晚期胃癌)课件,Whats your Next Choice?,Maintain Xeloda dosage,restart XELOX until HFS resolved to Grade 1,按原剂量XELODA开始,Reduce Xeloda dosage to 750mg/m,2,bid,将Xeloda剂量减为原剂量的75%后继续治疗,Interrupt,中断治疗,Change drug,更换药物,Radiotherapy,放疗,1.,2.,3.,4.,5.,2.7%,5.4%,2.7%,67.6%,21.6%,Whats your Next Choice?Main,Actual Treatment,TP(Docetaxel+CDDP),2,cycles/3 weeks,TP(泰素帝85mg/m2+顺铂)/3周重复,Relieve symptoms,症状改善,Still waiting for evaluation,等待评估,Actual TreatmentTP(Docetaxel+,