新辅助化疗治疗骨肉瘤

Neoadjuvant Chemotherapy Treating for Osteosarcoma

目的对38例采用新辅助化疗的骨肉瘤患者进行回顾性分析。方法38例骨肉瘤患者,按Enneking外科分期【1】均属ⅡB期的骨肉瘤。均采用新辅助化疗方案进行术前化疗、手术和术后化疗,第一周期大剂量MTX方案:MTX200mg/kg或8-12g/㎡;第二周期IFO方案:2-3g/㎡,连用5天;第三周期AP方案:用法ADM60mg/㎡、DDP120mg/㎡,每一周期间隔12天左右,三个周期为一个疗程,术前化疗1-2个疗程,2-3周后手术,术后3-4周后再化疗2-3疗程。结果38例患者,手术后均进行病理组织学评价,化疗反应呈显效者30例,占78.9%,化疗反应呈差者8例,占21.1%。两组患者1年生存率分别为92.8%、50%;2年生存率分别为71.4%,25%。结论新辅助化疗在综合治疗中占重要地位,化疗病理组织学评价是判断预后的最重要指标。

Objective We retrospectively analyzed 38 cases osteosarcom who were treated by neoadjuvant chemotherapy.Methods 38 osteosarcom cases were classified by Enneking classification into Stage ⅡB. They were treated by neoadjuvant chemotherapy regimen. The first period ,they were cured by huge-dose MIX regimen that was MTX 200mg/kg or 8-12g/m^2 . In the second period, they accepted IFO regimen that was IFO 2-3g/m^2 and continuously used 5 days. In the third period,they were treated by AP regimen that was ADM 60mg/m^2 and DDP 120mg/m^2 .The interval between periods was about 12 days. These three periods were realized as a treatment course. The patients were treated by one or two coursed preoperative chemotherapy.After 2 or 3 weeks,they accepted operation and were cured by 2 or 3 courses postoperative chemotherapy after 3 or 4 weeks.Results 38 cases were evaluated by hisopathology after post operation .30 case＇schemical reaction was significant and posed 78.9%.8 case＇s chemical reaction was bad and posed 21.1%. The 1-year survival rates of two groups were 92.8% and 50%,respectively.The 2-year survival rates were 71.4% and 25%,respectively. Conclusion We suggested that neoadjuvant chemotherapy would be important in combined treatment and the hisopathology evaluation were a important index to help doctors judging prognosis.