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영남의대학술지 Vol.24_No.2 Suppl. P.S391-398, Dec. 2007
Original Article
절제불능 위암 및 재발 위암환자에서 TS-1 단독 혹은 TS-1/CDDP 병용요법의 효과 및 부작용
Efficacy of Unresectable or Recurred Gastric Cancer Treated with TS-1 Chemotherapy or TS-1/CDDP Combination Chemotherapy
김세원, 김상운, 송선교
영남대학교 의과대학 외과학교실
책임저자：송선교, 대구광역시 남구 대명 5동 317-1, 영남대학교 의과대학 외과학교실
Tel: (053) 620-3586, Fax: (053) 624-1213
E-mail: sksong@med.yu.ac.kr
December 30, 2007
Abstract
Purpose：Although several chemotherapy regimens used against advanced and recurred gastric cancer have been studied extensively in an attempt to further improve the prognosis of patients, no standard chemotherapeutic regimens have been established. The aim of this study was to determine the anti-tumor efficacy and safety of TS-1 or TS-1 plus cisplatin (CDDP). Materials and Methods：From December 2004 to June 2007, we treated 43 patients with unresectable or recurred gastric cancer either with 80 mg/m2 of TS-1 for 28 days, which was followed by a 2-week rest, or with 80 mg/m2 of TS-1 for 28 days and 60 mg/m2 of CDDP on day 3 every 6 weeks. Results：Tumor response rates in the primary chemotherapy group and in the recurrent group were 46.7% and 21.4%, respectively. The median survival rates in the primary and the recurrent group were 14 months and 8 months, and it was not significantly different. But the one-year survival rates according to the kinds of regimens (TS-1 or TS-1/CDDP group) were significantly different (P=0.0014). The incidences of grade 3 or 4 adverse effects were 18%, respectively. Conclusion：The anti-tumor efficacy and safety of TS-1 and TS-1 plus CDDP in unresectable or recurred gastric cancer patients seemed to be high with modest adverse effects, thus suggesting the possible use of this regimen for unresectable or recurred gastric cancer patients.
Key Words: TS-1, Chemotherapy, Tumor response rate, Gastric cancer
References
	1. Korea national statistical office. Annual report of the cause of death statistics. 2004.
	2. Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono H, et al. Surgical outcomes for early gastric cancer in the upper third of the stomach. J Am Coll Surg. 2005 Jan;200(1): 15-9.
	3. Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H, Hada M. Should systematic lymph node dissection be recommended for gastric cancer? Eur J Cancer. 1998 Sep;34(10): 1480-9.
	4. Dickson JL, David C. Systemic treatment of gastric cancer. Eur J Gastroenterol Hepatol. 2004 Mar;16(3):255-63.
	5. Moertel CG. The natural history of advanced gastric cancer. Surg Gynecol Obstet. 1968 May;126(5):1071-4.
	6. Hermans J, Bonenkamp JJ, Boon MC, Bunt AM, Ohyama S, Sasako M, et al. Adjuvant therapy after curative resection for gastric cancer. Meta-analysis of randomized trials. Eur J Cancer. 1999 Jul;35(7):1059-64.
	7. Earle C, Maroun J. Adjuvant chemotherapy after curative resection for gastric cancer in non Asian patients. Revisiting a meta-analysis of randomized trials. 1999 Jul;35(7):1059-64.
	8. Mari E, Floriani I, Tinazzi A, Buda A, Belfiglio M, Valentini M, et al. Efficacy of adjuvant chemotherapy after curative resection for gastric cancer. A meta-analysis of published randomized trials. Ann Oncol. 2000 Jul;11(7): 837-43.
	9. Murad AM, Santiago FF, Petroianu A, Rocha PRS, Rodrigues MAG, Rausch M. Modified therapy with 5-fluorouracil, doxorubicin, and methotrexate in advanced gastric cancer. Cancer 1993 Jul 1;72(1):37-41.
	10. Pyrhonen S, Kuitunen T, Nyandoto P, Kouri M. Randomized comparison of fluorouracil epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancer. Br J Cancer 1995 Mar;71(3):587-91.
	11. Moon HS, Kang YS, Kim YS, Park KO, Lee ES, Sung JK, et al. Retrospective study on the therapeutic effects of an etoposide, adriamycin, cisplatin-II(EAP-II) versus an etoposide, leucovorin, 5-furorouracil(ELF) combination chemotherapy in unresectable gastric cancer. J Korean Cancer Assoc. 2003;3:122-7.
	12. Shirasaka T, Nakano K, Takechi T, Satake H, Uchida J, Fujioka A, et al. Antitumor activity of 1 M tegafur-0.4 M 5-chloro-2,4-dihydro- xypyridine-1 M potassium oxonate (S-1) against human colon carcinoma orthotopically implanted into nude rats. Cancer Res 1996 Jun 1;56(11): 2602-6.
	13. Shirasaka T, Shimamoto Y, Fukushima M. Inhibition by oxonic acid of gastrointestinal toxicity of 5-fluorouracil without loss of its antitumor activity in rats. Cancer Res 1993 Sep 1;53(17):4004-9.
	14. Sakata Y, Ohtsu A, Horikoshi N, Sugimachi K, Mitachi Y, Taguchi T. Late phase II study of novel oral fluoropyrimidine anticancer drug S-1 (1 M tegafur 0.4 M gimestat M otastat potassium) in advanced gastric cancer patients. Eur J Cancer 1998 Oct;34(11):1715-20.
	15. Koizumi W, Kurihara M, Nakano S, Hasegawa K. Phase II Study of S-1, a novel oral derivative of 5-fluorouracil, in advanced gastric cancer. Oncology 2000 Apr;58(3):191-7.
	16. Chollet P, Schoffski P, Weigang-Kohler K, Schellens JHM, Cure H, Pavlidis N, et al. Phase II trial with S-1 in chemotherapy-naive patients with gastric cancer. A trial performed by the EORTC early clinical study group (ECSG). Eur J Cancer 2003 Jun;39(9):1264-70.
	17. Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ, Welvaart K, Songun I, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med 1999 Mar 25;340(12): 908-14.
	18. Kodera Y, Sasako M, Yamamoto S, Sano T, Nashimoto A, Kurita A. Gastric cancer surgery study group of Japan clinical oncology group identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer. Br J Surg 2005;92(3):1103-9.
	19. Newman E, Marcus SG, Potmesil M, Sewak S, Yee H, Sorich J, et al. Neoadjuvant chemo- therapy with CPT-11 and cisplatin downstages locally advanced gastric cancer. J Gastrointest Surg 2002 Mar-Apr;6(2):212-23
	20. Barone C, Cassano A, Pozzo C, D’Ugo D, Schinzari G, Persiani R, et al. Long-term follow-up of a pilot phase II study with neoadjuvant epidoxorubicin, etoposide and cisplatin in gastric cancer. Oncology 2004;67 (1):48-53.
	21. Ajani JA, Faust J, Ikeda K, Yao JC, Anbe H, Carr KL, et al. Phase I pharmacokinetic study of S-1 plus cisplatin in patients with advanced gastric carcinoma. J Clin Oncol 2005 Oct 1;23(28):6957-65.
	22. Koizumi W, Tanabe S, Saigenji K, Ohtsu A, Boku N, Nagashima F, et al. Phase I/II study of S-1 combined with cisplatin in patients with advanced gastric cancer. Br J Cancer 2003 Dec 15;89(12):2207-12.
	23. Sakaguchi Y, Kabashima A, Okita K, Ojima Y, Yamamura S, Nishizaki T, et al. Long-term outcome of S-1 and cisplatin combination therapy inpatients with advanced or recurrent gastric cancer. Gastric Cancer 2005;8(2):111-6.
	24. Sugimachi K, Maehara Y, Horikoshi N, Shimada Y, Sakata Y, Mitachi Y, et al. An early phase II study of oral S-1, a newly developed 5-fluorouracil derivative for advanced and recurrent gastrointestinal cancers. Oncology 1999 Oct;57(3):202-10.