原发性骨肉瘤放化综合治疗的远期疗效

LONG-TERM EFFECT OF RADIOTHERAPY IN COMBINATION WITH CHEMOTHERAPY FOR PRIMARY OSTEOSARCOMA

对 37例原发性骨肉瘤进行局部介入和放射治疗后全身化疗 ,按不同治疗方式分 3组总结。A组 :局部介入和放疗后加全身化疗 1 8例 ;B组 :局部介入和放疗后 ,无或不足量全身化疗 1 4例 ;C组 :局部介入和放疗均在半量以下 ,无全身化疗 5例。除C组 5例外 ,余 32例连续随访 2 4～ 95个月。结果 :局部肿瘤控制率达 93.8% ( 30 /32 ) ,患肢活动功能障碍率从 93.8% ( 30 /32 )恢复为 4 0 .6 ( 1 3/32 )。 32例中位生存 (无瘤生存 )期为 38个月。A组病例按年度收治至随访截止时间例数计 2 ,3,5和 7年生存率分别为 :94 .4 % ( 1 7/1 8) ,92 .3% ( 1 2 /1 3) ,72 .7% ( 8/1 1 )和 5 0 % ( 3/6 )。 1 9例死于肺转移病例 ,总中位带瘤生存 1 3 6个月。 3组中位带瘤生存期分别为 :A组 1 8个月 ,B组 1 5个月和C组 6个月。A组病例的远期疗效优于B和C组 (P <0 .0 1 )。本治疗方案能提高原发性骨肉瘤的远期疗效 ,并对肺转移有抑制作用。

Thirty-seven patients with primary osteosarcoma treated with local radiation and arterial perfusion of cytotoxic agents followed by systemic chemotherapy from April 1986 to April 1992. Several patients themselves stopped the treatment. All patients were divided into 3 groups: Group A (18 cases) were treated by local radiation and arterial perfusion of DDP, followed by systemic chemotherapy; Group B (14 cases) were treated by local radiation and arterial perfusion with no or insufficient dose of systemic chemotherapy; Group C (5 cases) were treated by local radiation and arterial perfusion with insufficient half dose and no systemic chemotherapy. Except the patients in group C, all other patients(32 cases) were followed-up from 24 to 95 months. Local control rate of the tumors was 93.8%, hypokinesis rate of the limps decreased from 93.8% to 40.6%, and mean survival time with no evidence of cancer was 38 months after treatment . survival rates of 2,3,5 and 7 years in group A were 94.4%,92.3%,72.7% and 50%,respectively.The mean survival time from lung metastasis to death in 19 patients was 13.6 months. Our date showed that long term survival of group A was superior to other groups (P<0.001). We believe the optimum treatment plan could improve long term survival and control the lung metastasis.