目的：晚期胃癌的最佳化疗方案是什么？
结论：胃癌是全球癌症死亡的第二大原因。尽管安大略省的胃癌发病率很低，总体预后暗淡,在加拿大，5年生存率约为23%。即使有大量关于晚期胃癌化疗的研究，不确定性依然存在。没有公认的标准治疗，在实践中似乎存在地理差异。
结果：感兴趣的结果是总生存期，客观反应率(完全反应加部分反应)，疾病进展的时间，不利影响，和生活质量。
方法：经过系统评价，起草了一份包含与安大略省患者相关的临床建议的实践指南.实践指南已由胃肠道疾病站点小组（gidsg）和循证护理计划的报告批准小组审查和批准。安大略省从业者的外部审查是通过一项调查获得的，其结果被纳入实践指南。
结论：gidsg提出以下建议：为了提高生存率，任何联合化疗方案都应包括铂类药物.在联合化疗方案中，口服卡培他滨优于静脉注射5-氟尿嘧啶（5fu）-也就是说，表柔比星-顺铂-卡培他滨优于以前的标准方案，表阿霉素-顺铂-5fu（ecf）。表阿霉素-奥沙利铂-卡培他滨（eox）是ecf的合理替代品。ecf和eox之间的选择应基于患者的偏好。曲妥珠单抗联合顺铂和氟嘧啶（5fu或口服卡培他滨）被推荐用于人类表皮生长因子受体2（her2/neu）阳性的晚期胃癌。
OBJECTIVE: What is the optimal chemotherapy regimen in advanced gastric cancer?
CONCLUSIONS: Gastric cancer is the second leading cause of cancer mortality worldwide. Despite low incidence rates for gastric cancer in Ontario, the overall prognosis is bleak, with 5-year survival rates of approximately 23% in Canada. Even with the considerable body of research available on chemotherapy for advanced gastric cancer, uncertainty remains. There is no recognized standard treatment, and there appears to be geographic variation in practice.
RESULTS: Outcomes of interest were overall survival, objective response rate (complete plus partial responses), time to disease progression, adverse effects, and quality of life.
METHODS: After a systematic review, a practice
guideline containing clinical recommendations relevant to patients in Ontario was drafted. The practice
guideline was reviewed and approved by the Gastrointestinal Disease Site Group (gi dsg) and the Report Approval Panel of the Program in Evidence-Based Care. External review by Ontario practitioners was obtained through a survey, the results of which were incorporated into the practice
guideline.
CONCLUSIONS: The gi dsg makes the following recommendations: To improve survival, a platinum agent should be included in any combination chemotherapy regimen.Within a combination chemotherapy regimen, oral capecitabine is preferred over intravenous 5-fluorouracil (5fu)-that is, epirubicin-cisplatin-capecitabine is preferred over the prior standard regimen, epirubicin-cisplatin-5fu (ecf).Epirubicin-oxaliplatin-capecitabine (eox) is a reasonable alternative to ecf. The choice between ecf and eox should be based on patient preference.Trastuzumab in combination with cisplatin and a fluoropyrimidine (5fu or oral capecitabine) is recommended for advanced gastric cancer positive for the human epidermal growth factor receptor 2 (her2/neu).
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