| Objective:Toxicities and response are different when patients with advanced esophageal cancer were treated with standard FLP(5-FU/CF/PDD) regimen.Serum level of dihydropyrimidine dehydrogenase(DPD) relates to efficacy and toxicities of chemotherapy containing 5-fluorouracil(5-FU).This study was to explore relationship of DPD to clinical feature,treatment response and adverse event in esophageal cancer patients treated with FLP regimen.And to explore the feasibility that clinical T,N stage was applied to response evaluation of the neo-adjuvant chemotherapy.Methods:The DPD activity in blood with esophageal cancer patients was detected by high-performance liquid chromatography(HPLC) before chemotherapy.The chemotherapy protocol was FLP that consisted of leucovorin(100mg/d),5-fluorouracil (500mg/d) and cisplatin(20mg/d) from day 1 to day 5,4 weeks as a cycle.Adverse events of the chemotherapy were scored according to CTCAE3.0 for the patients.The TNM staging in the patients who received neo-adjuvant confirmed by barium meal X-ray film and CT scans.And the responses were evaluated according to RECIST after 2 cycles chemotherapy.Results:The group of neo-adjuvant chemotherapy was 68 cases that included T12 cases, T2 31 cases,T3 24 cases and T4 11 cases,and corresponded clinical stage wereⅢphrase 45 cases andⅣphrase 23 cases.The DPD activity in blood was expressed in normal distribution(ranged from 1.72 to 6.79).The mean value was 3.27,and standard deviation was 1.35.The DPD activities were much variable among patients,but none of them were thorough deficient.The DPD activity had no correlation with sex,age, X-rays type,and also staging of the tumor and KPS(P＞0.05).The toxicities of chemotherapy were slight,and no case was discontinued chemotherapy because of severe adverse events.Spearman analysis demonstrated that DPD activity correlated with chemotherapy:oxicities including myelosuppression,diarrhea and oral mucositis (P＜0.05).Therapy response could be evaluated in 68 cases,in which CR 1 case,PR 24 cases.The RR was 5.6.8%.The mean value of the DPD activity was lower in the group of chenotherapy-responsive patients than in the group of ineffective patients(2.31 and 3.53 respectively),and had statistical significance between the groups(P＜0.05).Conclusions:Chemotherapy with FLP protocol for esophageal cancer is safe and convenient.The treatment response and adverse event had a negative correlation with DPD activity in blood(P＜0.05).The DPD activity in blood had no correlation with common clinical feature of the patients.Clinical T and N stage evaluation according to barium meal X-ray film and CT scans are consistent with RECIST and more convenient for the judgement of response in neo-adjuvant chemotherapy of esophageal cancer.It can prognose the tox:cities and therapeutic effects and provide the theoretic bases for individualized therapy by detecting the level of blood DPD activity. |
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