大剂量异环磷酰胺治疗进展期软组织肉瘤的疗效评价

Effect of continuous-infusion with high-dose ifosfamide on advanced soft tissue sarcomas

目的：评价大剂量异环磷酰胺治疗进展期软组织肉瘤的临床疗效和不良反应。方法：进展期软组织肉瘤患者24例，异环磷酰胺总量14g／m^2持续灌注24h，第1～6天行常规美斯钠（mesna）解毒和水化，28d为1个周期，共完成1～4个周期，中位周期数为3。结果：全组患者CR3例（12．5％），PR8例（33．3％），SD8例（33．3％），PD5例（20．8％），总有效率45．8％（11／24）。接受一线和二线化疗患者为5例和19例，一线化疗3例获CR或PR；二线化疗8例获CR或PR。主要毒副反应为骨髓抑制，其白细胞Ⅲ～Ⅳ度下降发生率为51．4％，其他不良反应少见。结论：大剂量异环磷酰胺是治疗进展期软组织肉瘤有效化疗方案，患者缓解率较高，毒副反应可以耐受，值得临床进一步观察。

Objective：To evaluate the efficacy and adverse reaction of continuous infusion with high-dose ifosfamide on soft tissue sarcoma （STS）. Methods： Twenty four patients with advanced soft tissue sarcoma were given a 24 h continuous infusion of ifosfamide at a total dose of 14 g/mz. From d 1 to d 6 adequate mesna were given for protection and hydration. Twenty eight days were regarded as one cycle and 1-4 cycles were completed. The median cycle number was 3. Results：Three cases had com- plete remission （CR） （12.5%）, 8 cases achieved partial remission （PR） （33.3%）, 8 cases maintained a stable disease （SD） （33.3%）, and 5 cases had progressive disease （PD） （20. 8%）. The overall response rate （RR） was 45.8% （11/24）. Five patients received first line chemotherapy and 3 cases achieved CR or PR. Ninteen patients received second line chemotherapy and 8 cases achieved CR or PR. The main adverse reaction was myelosupression. Neutropenia at grade Ⅲ-ⅣV occurred in 51.4% patients. Other adverse reactions were seldom observed. Conclusion：Continuous infusion of high-dose ifosfamide is effective for STS. The RR is high and the side effects can be tolerable. So its clinical effect is worthy of further observation.