动静脉联合化疗与单纯静脉化疗对骨肉瘤疗效的比较

The preliminary result of comparative analysis of intra-arterial perfusion of cisplatin and intravenous chemotherapy in osteosarcoma treatment

目的探讨术前顺铂动脉灌注化疗在改善骨肉瘤患者无瘤生存预后方面的价值。方法对24例行保肢术的IIB期膝关节周围骨肉瘤患者进行随访,其中12例患者术前行顺铂动脉灌注和表阿霉素静脉化疗,另外12例患者行静脉化疗,比较两组的无瘤生存率和生存时间。结果顺铂动脉灌注化疗组累计3年无瘤生存率为54.6%,而静脉化疗组累计3年无瘤生存率为50%,两组无瘤生存率无统计学差异(P=0.1497),Cox多因素分析提示化疗给药方式不是影响无瘤生存预后的独立因素(P=0.078)。结论术前顺铂动脉灌注化疗并不能改善骨肉瘤患者的无瘤生存预后,考虑到其相对高昂的费用和不良反应,多药联合静脉化疗仍是目前首选的术前化疗方式。

Objective To discuss the value of preoperativeintra-arterialperfusionofcisplatinin osteosarcoma treatment. Methods 24 cases of IIB osteosarcoma around knee joints who received limb salvage surgery were followed-up. 12 cases received preoperatively intra-arterial perfusion of cisplatin and intravenous epirubicin and other 12 cases received intravenous chemotherapy of both. Their disease free survival rates were compared. Results The cumulative 3 years disease-free survival rate of those who received preoperative intra-arterial perfusion of cisplatin was 54.6%,which of those receiving intravenous chemotherapy was 50%. There was no statistical difference between them （P=0. 1497 ）.Multivariate analysis using Cox model showed that the mode of chemotherapy （intra-arterial or intravenous） was not an independent factor for disease-free survival （P=0.078）. Conclusions Compared with intravenous chemotherapy, preoperative intra-arterial perfusion of cisplatin can not improve the disease-free prognosis of osteosarcoma. Considering the large expense and side effects of intra-arterial chemotherapy, intravenous multi-drug chemotherapy is still the first choice for preoperative chemotherapy in osteosarcoma treatment.