新辅助化疗结合手术治疗原发性骨肉瘤25例

Neoadjuvant Chemotherapy Combined with Surgical Treatment of Primary Osteosarcoma: A Report on 25 Cases

目的探讨新辅助化疗结合手术治疗肢体原发性骨肉瘤的临床效果。方法本组患者25例,术前行新辅助化疗,根据化疗临床效果行肿瘤的广泛切除人工肿瘤关节置换保肢术或截肢术,术后继续化疗,根据肿瘤坏死率大小决定术后化疗方案,对肿瘤坏死率≥90%者,继续术前化疗方案;对术前化疗效果不佳或肿瘤坏死率〈90%的患者术后化疗加用依托泊苷或更改化疗方案。结果25例患者均获随访,随访时间11个月～6年。25例中2例术前化疗临床效果差,行截肢术,其余23例均行肿瘤广泛切除特制肿瘤关节置换治疗,5年带瘤生存率68%,5年无瘤生存率64%,局部复发率16%。关节置换患者术后肢体功能恢复的平均时间为6周。结论新辅助化疗结合手术治疗肢体原发性骨肉瘤是较理想的治疗方式。

Objective To investigate the combination of neoadjuvant chemotherapy combined with surgical treatment of primary osteusarcoma clinical effect. Methods All the 25 cases, preoperative neoadjuvant chemotherapy, according to the clinical effects of chemotherapy, a wide range of tumor resection with arthroplasty artificial limb salvage surgery or amputation, chemotherapy after surgery, according to the size of the tumor necrosis rate to decide the chemotherapy after surgery, of the tumor necrosis rate of ≥ 90% or more, to continue the program of pre-operative chemotherapy; in the chemotherapy after the operation, the effect of preoperative chemotherapy on the poor or the tumor necrosis rate 〈90% of the patients to plus Etoposide or change chemotherapy. Results The results of 25 patients were followed up for 11 months to 6 years. In 25 cases of pre-operative chemotherapy in two cases of poor clinical results, to amputation, and the remaining 23 cases were performed wide range of tumor resection with arthroplasty artificial limb salvage surgery. 5-year survival rate with 68%, 5-year disease-free survival rate of 64%, local recurrence rate of 16%. The average time of the restoration of limb function after surgery is 6 weeks. Conclusions Neoadjuvant chemotherapy combined with surgical treatment of primary osteosarcoma is the preferred treatment.