成骨肉瘤新辅助化学药物治疗的疗效分析

:100044()19967200212,113,65,48,732:6,4,49,37,2,1,7,3,1,1,1(Enneking):A7,B1062,360,35,183,7,27,5(813%),12(55%)60,11,1813%10,35,13,37%18,14,78%113Kaplan2Meyer,571193%:(1);(2)(ADM)(CDP),,,(MTX)(IFO),;(3),IFO;(4),,,,;(5),,;(6),;NeoadjuvantchemotherapyforosteosarcomaGUOWei,YANGRong2li,TANGXiao2dong,TANGShun,LIDa2sen,YANGYi.MusculoskeletalTumorCenter,PeoplesHospital,PekingUniversality,Beijing100044,ChinaAbstractObjectiveTosummarizetheexperienceinneoadjuvantchemotherapyforosteosarcoma.MethodsBetweenJuly1996andDecember2002113patients,65malesand48females,aged731,withosteosarcomalocatedinpelvis(n=2),sacrum(n=1),proximalfemur(n=6),shaftoffemur(n=4),distalfemur(n=49),proximaltibia(n=37),shaftoftibia(n=2),distaltibia(n=1),fibula(n=3),scapula(n=1),clavicle(n=1),orproximalhumerus,(n=7)withoutmetastasis,7ofwhichbeingattheEnneckingstageofAand106ofwhichbeingatthestageofB,underwent2cyclesofchemotherapywithhighdosemethotrexate(MTX)preoperativelyandthenoperation.IfpoorresponsewasobservedafterthefirstcycleofchemotherapyMTXwasabandonedandoperationwasperformedimmediately.Twenty2twopatientsunderwentreimplantationofdevitalizedtumorboneand80patientsunderwentprostheticreplacement.Theprotocolofcisplatin,ifosfamide,andpaclitaxelwasadoptedafteroperation.Atleast3cyclesofchemotherapyweregivenpostoperativelyforallpatients.Thepatientswerefollowedupfor2066months.ResultsSixtypatientsshowedexcellentresponsetothepreoperativechemotherapy,35showedgoodresponse,and18showedpoorresponse.Relapseoftumorwasfoundin12outofthe22patients(55%)receivingreimplantationofdevitalizedtumorboneandin5outofthe60patients(8.3%)receivingprostheticreplacement.The52yearsurvivalrateofthewholegroupwas71.93%.Thelungmetastasisrateswere18.3%,37%,and78%inthepreoperativeexcellentresponsegroup,goodresponsegroup,andpoorresponsegrouprespectively.ConclusionTheneoadjuvantchemotherapyprotocolwiththesecond2linedrugssuchasifosfamideandpaclitaxelusedtothepatientsrespondingpoorlytoMTXismoreeffectivethantheolderprotocol.Localarterialchemotherapyisfeasible.KeywordsOsteosarcoma;Drugtherapy681120047178414NatlMedJChina,July17,2004,Vol84,No.14©1995-2005TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.20,,,(),(neo2adjuvantchemotherapy),,,,520%[123]580%[4],550%60%[5,6]2070610,,,90%,,580%90%,550%,,11:1996720011211365,48,732:6,4,49,37,2,1,7,3,1,1,1(Enneking):A7,B1062,1,,,,(HD2MTX),(IFO)21:(1),,,,,,(2),X,,,CT(3),(4),,(5),Huvos[7]31:6012,22,(7);5;2;12,,,,95%30min2,MTXIFO,1Kaplan2Meier3:(1):,,,,,,,X,,,CT,,Huvos(2):,,,,X,,,CT,,781120047178414NatlMedJChina,July17,2004,Vol84,No.14©1995-2005TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.,Huvos(3):,,,X,,,CT,,Huvos12Kaplan2Meier3Kaplan2Meier60,35,183,6,26200/ml,:,,,5(813%),12(55%)2,1,,(ISOLS)25,13()60,11,1813%;10,()35,13,37%()18,14,78%,2,55%,113EnnekingKaplan2Meier,571193%,(1,23)1113(%)5(%)601118158817135133710701591814781016167,,,,,,(CDP)16g/g,60%90%,CDP12g/g,40%Picci[8]79CDP,HD2MTX(ADM)3,CDP,90%78%,46%[8211]2080,,80%,550%[5,6],HD2MTXCDPADMIFO,,,881120047178414NatlMedJChina,July17,2004,Vol84,No.14©1995-2005TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.:(1),,ADM6080mg/m2,CDP100120mg/m2,MTX812g/m2,IFO2gm-2d-1(2)ADMCDP,MTXIFO,,,(3)(HD2MTXCDPADM),IFO(4),,,,(5),,(6)23,,,35(7),[12],53,,,,2,55%,,,,,,20%20min,95%20min,;,;,,,,;,,;,(ADR)(DDP),[11];[13215],,[16,17],,,(G2CSF)(ABMT)/(PBSCT)G2CSF,,,,,,1WittigJC,BickelsJ,PriebatD,etal.Osteosarcoma:amultidisciplinaryapproachtodiagnosisandtreatment.AmFamPhysician,2002,65:112321132.2PaulussenM,FrohlichB,JurgensH.Ewingtumour:incidence,prognosisandtreatmentoptions.PaediatrDrugs,2001,3:8992913.3UchidaA,MyouiA,ArakiN,etal.Neoadjuvantchemotherapyforpediatricosteosarcomapatients.Cancer,1997,79:4112415.4TsuchiyaH,TomitaK,MoriY,etal.Marginalexcisionforosteosarcomawithcaffeineassistedchemotherapy.ClinOrthop,1999,358:27235.5CaiYB,NiuXH,ZhangQ,etal.Long2termresultsofcombinedtherapyforprimaryosteosarcomainextremities.ChinJSurg,2000,38:3292331.,,,..,2000,38:3292331.6MaZT,LiHG,ShiXD.Chemotherapyandresultsofosteosarcoma.ChinJOrthop,2000,20suppl1:s442s46.,,..,2000,20():44246.7HuvosAG,RosenG,MarcoveRC.Pathologicaspectsin20patientsaftertreatmentwithchemotherapy,enblocresection,andprostheticbonereplacement.ArchPatholLabMed,1977,101:14218.8PicciP,BacciG,FerrariS,etal.Localrecurrenceafterlimbsalvageproceduresforosteosarcoma:correlationwithmarginsandchemotherapyinducednecrosis.JBoneJointSurg(Am),1993,57(suppl2):2112215.9FergusonWS,GoorinAM.Currenttreatmentofosteosarcoma.CancerInvest,2001,19:2922315.10BacciG,FerrariS,LariS,etal.Osteosarcomaofthelimb.Amputationorlimbsalvageinpatientstreatedbyneoadjuvantchemotherapy.JBoneJointSurg(Br),2002,84:88292.11BacciG,FerrariS,BertoniF,etal.Histologicresponseofhigh2gradenonmetastaticosteosarcomaoftheextremitytochemotherapy.ClinOrthop,2001,386:1862196.12GuoW,ZengC,DongF,etal.Paclitaxel2inducedapoptosisinosteosarcomacelllineU22OS.ChinMedJ,2002,115:179621801.13SerraM,ScotlandiK,ManaraMC,etal.AnalysisofP2981120047178414NatlMedJChina,July17,2004,Vol84,No.14©1995-2005TsinghuaTongfangOpticalDiscCo