目的：研究替吉奥治疗晚期胃癌的安全性、并发症以及剂量调整影响因素。方法110例接受含替吉奥化疗方案的胃癌患者入组本研究。根据体表面积确定替吉奥用量，小于1.25m2者40mg/次；1.25～1.5m2者50mg/次；大于1.5m2者60mg/次，每日两次。单药口服21d，28d为一周期；联合用药口服14d，21d为一周期。结果全程完成治疗的患者占83.64%，24例患者由于毒性不能耐受调低剂量、更改方案或停止化疗。调整剂量最常见的原因为胃肠道反应16例，表现为恶心呕吐、腹痛腹泻和口腔溃疡，其余为骨髓抑制4例，肺部感染2例，间质性肺炎1例，皮疹1例。出现神经毒性副作用19例，但均为1~2度，患者未因此调整剂量。多因素分析显示，ECOG评分是影响剂量调整的因素。结论替吉奥辅助治疗胃癌服用方便、有效，副作用比较轻微，适合与多种化疗药物组合成化疗方案，但是对于ECOG评分为2分的患者，要注意选择合适的方案和剂量，密切观察患者不良反应的发生。%Objective To examine the complication,security and factors on influencing dose regulation of S-1 chemotherapy in advanced gastric cancer. Methods 110 patients who received S-1 alone or combination chemotherapy in-cluding S-1 were enrolled. The S-1 dosage schedule was depended on body surface area and was given orally at 40mg (≤1.25m2), 50mg (1.25~1.5m2) and 60mg(≥1.5m2) bid for 21 consecutive days (S-1 alone) or 14 days (combination chemotherapy) with a resting period of 7 days. Results Among these 110 patients, 83.64%(92/110) patients ended the chemotherapy on schedule. 24 patients reduced the dose or changed regimen or stopped chemotherapy. The most common dose regulation events were gastroin-testinal (16/24) which included nausea, vomiting, diarrhoea and stomatitis. Other severe adverse events included hematological toxicity (4/24), pulmonary infection (2/24), interstitial pneumonia (1/24), skin rash (1/24). Although neurotoxicity was com-mon adverse event (19/110), no one regulated the dose in this condition. ECOG was detected as independent factor influencing dose regulation in multivariate analysis. Conclusion Chemotherapy regimen including S-1 is feasible and safe in patients with advanced gastric cancer. ECOG is the most important factor influencing dose regulation. Patients with an ECOG score of 2 , should select appropriate chemotherapy and dose, and should be observed the adverse events.
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