| Background and objectivesPancreatic cancer(PC) is one of the most lethal digestive system tumors with a 5-year survival rate less than 5%. According to the latest cancer data released by the American Cancer Society, PC reached the fourth leading cause of cancer-related mortality worldwide. Domestic and foreign researches show that: Although surgical removal is the only effective way to cure, almost 80% of new cases at the time of diagnosis are local development and metastasis, lost the opportunity to operate. Even in patients who has been operated complete surgical resection followed by adjutant chemotherapy with or without radiation, the risk for systemic recurrence can be as high as 77%. Therefore, chemotherapy is the most vital method for advanced pancreatic cancer's treatment. The population is aging, and because the incidence of cancer increases with age, the population of patients with cancer is growing. More than 50% of all newly diagnosed patients with cancer are older than 60 years, and more than one third are over the age of 70. Pancreatic cancer always occurs in older than 40 years old, the 70-90 years is the peak age of pancreatic cancer. At present, although operation is the best option, many older patients are not recommended for surgery. The elderly patients with chemotherapy have many challenges including the following three aspects: Firstly, basic diseases maybe affect chemotherapy: many age-related diseases such as coronary heart disease, diabetes are common in elderly patients, which lead to a hypercoagulative state. However, the hypercoagulative state of PICC venous thrombosis caused by the formation of the tube, which will increase the risk in cancer patients. Secondly, the overall physiological function decline: for example, with the increase of age, the organ reserve capacity decreased, and the amount of bone marrow hematopoietic stem cell differentiation were significantly decreased, which will lead to the risk of hematologic toxicity occurrence increase; Finally, the dose adjustment for most elderly patients: In order to prevent serious adverse reactions, adjusting the dose regularly which may reduce the treatment effect; Therefore chemotherapy therapy selection needs to consider the physical condition of patients, the physical status score, complications and tolerance of treatment. In 1997, Gemcitabine as the first-line chemotherapy drugs is recommended in the treatment of elderly patients with advanced pancreatic cancer, although Gemcitabine can prolong overall survival(OS) rate, but it is still poor to improve the long-term prognosis for elderly cancer patients. The treatment of elderly patients with advanced pancreatic cancer is still not satisfactory. S-1 as a new type of fluorouracil oral chemotherapy drug, its effectiveness has been confirmed in many kinds of malignant tumors especially in gastrica carcinoma. A phase II clinical study conducted in Japan in 2005 shows that: the response rate of S-1 in the treatment of the metastasis pancreatic cancer was 21.1%. Currently due to lack of guidelines for treatment on elderly patients with pancreatic cancer and the fact that elderly patients is often accompanied with a variety of diseases, poor general condition score, most patients only tolerate a single drug treatment. This paper aims at reviewing 62 cases of elderly patients with advanced pancreatic cancer in the Department of Oncology of the First Affiliated Hospital of Zhengzhou University from April 2013 to April 2014, all patients received Gemcitabine or S-1 alone as the first-line chemotherapy, the curative effect of patients in the two groups were compared from progression free survival and the quality of life and chemotherapy tolerance, so as to provide a theoretical support for the using of S-1 in elderly patients with advanced pancreatic cancer. MethodsSixty-two elderly patients with advanced pancreatic cancer were collected from April, 2013 to April, 2014 in the First Affiliated Hospital of Zhengzhou University. All patients were confirmed by cytology or pathology as pancreatic carcinoma. They are all aged over 60 years; locally advanced or distant metastasis; untreated radiotherapy and chemotherapy previously; expected survival time more than 3 months; with imaging examination showed measurable lesions; Group(ECOG) performance status of 1 or 2; Panofsky performance status over 60; Sixty-two cases were divided into experimental group and control group. They all separately treated with S-1 capsule alone or Gemcitabine alone. Continues treatment is conducted until progression or intolerable side-effects. All Patients signed the informed consent for chemotherapy. ResultAmong Sixty-two patients treated with 2 cycles of chemotherapy, the number of the patients whose response to chemotherapy can be evaluated is 62. Experimental group: complete response(CR) is zero case, partial response(PR) is six cases, stable disease(SD) is thirteen cases, progressive disease(PD) is twelve cases, the disease control rates(DCR) was 61.3%(19/31); Control group: the separate number of cases for different endings is complete response(CR) zero, partial response(PR) seven, stable disease(SD) fourteen, progressive disease(PD) ten, the disease control rate was 67.7%(21/31), compared the disease control rate of two groups, there is no statistical significance between them(P>0.05). The treatment of two groups can improve the quality of life. The toxicity effects of the two groups were thrombocytopenia, anemia, gastrointestinal reactions, oral ulcer, hand-foot syndrome, skin rash, alopecia, fatigue, peripheral neuropathy and so on, the III-IV degree adverse reaction was mainly bone marrow suppression, the rate of III-IV degree of bone marrow inhibition in control group was 29.0%, it is significantly higher than the experimental group(6.5%), the difference was statistically significant(P<0.05); The two group of white blood cells reduce contrast: the incidence rate of experimental group was 41.9%, the incidence rate of control group was 48.4%, there is no statistical significance between them(P > 0.05); thrombocytopenia contrast: the incidence rate of experimental group was 16.1%, the incidence rate of control group was 45.2%, there is statistically significance between them(P<0.05), nausea and vomiting during chemotherapy were common, but there were no serious digestive system reactions, the incidence contrast: experimental group was 41.9%; control group: 54.8%, there is no statistical significance between them(P >0.05); the incidence of oral mucositis comparison: experimental group was 29%, control group was 19.4%, there is no statistical significance between them(P>0.05). Other adverse reactions incidence rate of the control group and the experimental group was low, and the difference is not significant, the side reactions occurred during the chemotherapy can return to normal after the treatment of remission, and there are no cases to terminate because of the toxicity. Until the date of follow-up, the median PFS of the control group and the experimental group respectively were 3.2 months(95%CI,1.455-4.945)and 3.0 months(95%CI,1.582-4.418). The median survival time of control group and the experimental group was no significant difference(?>0.05). Conclusion1. S-1 as the first-line treatment of elderly patients with advanced pancreatic cancer, the efficacy is equal with Gemcitabine; it can improve the clinical benefit rate, prolong PFS time and make sure patients with pancreatic cancer live a higher quality life.2. S-1 as the first-line treatment of elderly patients with advanced pancreatic cancer, compared with Gemcitabine monotherapy, the adverse reactions is light, the incidence of III- IV degree of bone marrow suppression and platelet reduce is low; the route of administration is convenient, it is worth further study and promotion. |
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