大剂量IFO治疗骨及软组织肉瘤的泌尿系统毒性分析

The Toxicity in Urogenital System by High-dose Ifosfamide Chemotherapy in Osteosarcoma and Soft tissue Sarcoma

目的探讨IFO在骨及软组织肉瘤化疗中的副作用。方法应用含有IFO的化疗方案化疗骨及软组织肉瘤38例,共88个疗程。IFO化疗剂量2g/m2,连续5天,共76个疗程;减量组IFO1.2g/m2,连用3～5天,共12个疗程。化疗毒副作用依据WHO化疗药物急性及亚急性不良反应分度标准判断。结果因高龄、肾功能异常致初次化疗减量者4例,因严重骨髓抑制至第2个疗程减量者2例。出现Ⅳ度以上白细胞减少者化疗15个疗程(17.0%)。出现Ⅱ度以上恶心、呕吐者化疗54个疗程(61.3%)。出现Ⅱ度以上血尿、出血性膀胱炎者化疗8个疗程(9.0%),出现肉眼血尿者化疗2个疗程(2.3%),其中1例于化疗后1周出现,且为Ⅲ度血尿,其余均于化疗中后期出现。结论在充分补液及应用美斯纳解毒时,应用大剂量IFO治疗骨软组织肉瘤疗效较好,无严重毒副作用。

Objective To investigate the side effects of ifosfamide (IFO) in the treatment of osteosarcoma and soft tissue sarcoma.Methods We studied 38 cases of osteosarcoma and soft tissue sarcoma treated by high-dose IFO chemotherapy.Of the 88 courses completed,IFO was given in 2 g/m2 continual infusion for 5 days in 76 courses,and 1.2g/m2 in 12 courses due to the treatment toxicities.Results Dose modifications were made in 4 patients in the first course of chemotherapy due to the old age or renal dysfunction,in 2 cases for severe myelosuppression during the second course of treatment.Grade IV leucopenia was nted in 15 courses (17%),Grade Ⅱ or greater gastrointestinal toxicities were noted in 54 courses (61.3%),Grade Ⅱ or greater hematuria or hemorrhagic cystitis was observed in 8 courses (9.0%),in which 7 were in the later courses of chemotherapy and 1 was observed 1 week after the first course of treatment.Conclusion The curative effect of high-dose IFO is satisfying,and the toxicities are acceptable by sufficient fluid infusion combined with Mesna.