成骨肉瘤新辅助化学药物治疗的疗效分析

Neoadjuvant chemotherapy for osteosarcoma

目的 探讨恶性骨肿瘤新辅助化学药物治疗 (化疗 )的治疗经验。方法 自 1996年 7月至 2 0 0 2年 12月 ,对 113例成骨肉瘤的患者实施了术前化疗 ,局部广泛切除加术后化疗。其中男6 5例 ,女 4 8例 ,年龄 7～ 32岁。肿瘤部位包括 :股骨近端 6例 ,股骨干部 4例 ,股骨远端 4 9例 ,胫骨近端 37例 ,胫骨干部 2例 ,胫骨远端 1例 ,肱骨近端 7例 ,腓骨 3例 ,锁骨 1例 ,肩胛骨 1例 ,骨盆骶骨各 1例。外科分期 (Enneking ) :ⅡA 7例 ,ⅡB 10 6例。术前化疗 2个周期 ,术后继续行 3个周期的化疗。结果 完全有效者 6 0例 ,部分有效者 35例 ,对术前化疗无效者 18例。所有术后患者的中位随访时间为 3年半 ,最长者 7年 ,最短者 2 7个月。不同的手术方式术后局部复发率不同 ,人工关节置换组局部复发 5例 ( 8 3% ) ,肿瘤骨灭活再植组局部复发 12例 ( 5 5 % )。对术前化疗反应好的 6 0例患者 ,随访期间有 11例患者出现肺转移 ,占 18 3%。其中有 10例局部复发 ,均为行肿瘤骨灭活再植及灭活骨复合人工关节置换的患者。对术前化疗反应中等的 35例患者中 ,13例出现肺转移 ,占 37%。对术前化疗反应差的 18例中 ,14例出现肺转移 ,约占 78%。对本组 113例成骨肉瘤的治疗结果进行了Kaplan Meyer生存曲线分析 ,5年生存率为 71 93%。?

Objective To summarize the experience in neoadjuvant chemotherapy for osteosarcoma. Methods Between July 1996 and December 2002 113 patients, 65 males and 48 females, aged 7～31, with osteosarcoma located in pelvis ( n =2), sacrum ( n =1), proximal femur ( n =6), shaft of femur ( n =4), distal femur ( n =49), proximal tibia ( n =37), shaft of tibia ( n =2), distal tibia ( n =1), fibula ( n =3), scapula ( n =1), clavicle ( n =1), or proximal humerus, ( n =7) without metastasis, 7 of which being at the Ennecking stage of ⅡA and 106 of which being at the stage of ⅡB, underwent 2 cycles of chemotherapy with high dose methotrexate (MTX)preoperatively and then operation. If poor response was observed after the first cycle of chemotherapy MTX was abandoned and operation was performed immediately. Twenty two patients underwent reimplantation of devitalized tumor bone and 80 patients underwent prosthetic replacement. The protocol of cisplatin, ifosfamide, and paclitaxel was adopted after operation. At least 3 cycles of chemotherapy were given postoperatively for all patients. The patients were followed up for 20～66 months. Results Sixty patients showed excellent response to the preoperative chemotherapy, 35 showed good response, and 18 showed poor response. Relapse of tumor was found in 12 out of the 22 patients (55%) receiving reimplantation of devitalized tumor bone and in 5 out of the 60 patients (8.3%) receiving prosthetic replacement. The 5 year survival rate of the whole group was 71.93%. The lung metastasis rates were 18.3%, 37%, and 78% in the preoperative excellent response group, good response group, and poor response group respectively. Conclusion The neoadjuvant chemotherapy protocol with the second line drugs such as ifosfamide and paclitaxel used to the patients responding poorly to MTX is more effective than the older protocol. Local arterial chemotherapy is feasible.