环磷酰胺联合羟基喜树碱二线治疗进展期尤文肉瘤的临床观察

Clinical observation of cyclophosphamide combined with hydroxycamptothecin as second-line treatment on advanced Ewing's sarcoma

目的探讨环磷酰胺(CTX)联合羟基喜树碱(HCPT)二线治疗进展期尤文肉瘤的疗效和不良反应。方法收集一线化疗失败的进展期尤文肉瘤患者27例,给予CTX联合HCPT治疗,具体为:CTX 0.6g/m2静推,d1;HCPT 6mg/m2静滴,d1～d5,21天为1周期。观察患者的疗效和不良反应。结果 27例患者均可评价疗效及不良反应。全组患者获CR 2例(7.4%),PR 6例(22.2%),SD 14例(51.9%),PD 5例(18.5%),有效率为29.6%(8/27),疾病控制率为81.5%(22/27)。主要不良反应为骨髓抑制、胃肠道反应和脱发。所有患者随访5～24个月,无进展生存期(PFS)为3～10个月,中位PFS为7个月;总生存期(OS)为5～18个月,中位OS为11个月;1年生存率为48.1%。至2010年11月死亡9例,无化疗相关性死亡,无瘤生存2例,带瘤生存16例。结论进展期尤文肉瘤患者一线化疗失败后用CTX联合HCPT二线治疗能够有效控制肿瘤进展,不良反应可以耐受,值得进一步深入研究。

Objective To evaluate the efficacy and adverse effect of cyclophosphamide combined with hydroxycamptothecin as the second-line treatment for advanced Ewing＇s sarcoma（EWS）. Methods Twenty-seven patients with advanced Ewing＇s sarcoma failed with the first-line chemotherapy of VAC/IE regimen were given cyclophosphamide（0.6g/m^2 ivp d1） and hydroxycamptothecin（6mg/m^2 iv d1-d5）.Twenty-one days were regarded as a cycle.Progression-free survival（PFS）,overall survival（OS）,1-year survival rate and adverse effect were observed. Results Efficacy and adverse effect could be evaluated in the 27 patients.Two cases had CR（7.4%）,6 cases achieved PR（22.2%）,14 cases maintained SD（51.9%）,and 5 cases had PD（18.5%）.The overall response rate was 29.6%（8/27）,and disease control rate was 81.5%（22/27）.The main adverse reactions were bone marrow suppression,nausea,vomiting and alopecia.The follow-up was 5-24 months.PFS was 3-10 months and median PFS was 7 months.Overall survival was 5-18 months and median OS was 11 months.The 1-year survival rate was 48.1%. Conclusion The chemotherapy regimen of cyclophosphamide combined with hydroxycamptothecin as second-line treatment for advanced Ewing＇s sarcomas can control disease progression effectively and the adverse effects are tolerable,worthing a further study.