顺铂、异环磷酰胺与阿霉素联合化疗治疗骨肉瘤的疗效观察

A curative observation of the DIA combined chemotherapy in treating the osteosarcoma

背景:随着现代肿瘤理论及诊治手段的发展,骨肉瘤的治疗目的不能仅满足于生存率的提高,更要提高患者的生活质量。治疗原则已转变为在肿瘤根治、追求生存的同时更多关注功能维持和心理健康。目的:观察顺铂(DDP)、异环磷酰胺(IFO)与阿霉素(ADM)联合化疗(DIA方案)治疗原发性骨肉瘤的疗效及对患者心理行为及生存质量的影响。方法:2004年1月至2011年11月应用DIA方案治疗51例骨肉瘤患者,男32例,女19例;年龄6～51岁,平均18岁;ⅡB期48例,Ⅲ期3例。对所有患者进行随访,计算5年无瘤生存率,对长期生存患者参照MSTS93评分标准进行患肢功能评价,采用90项自觉症状自评量表(SCL-90)和中文版医学结局研究简明调查表(SF-36)进行心理行为与生存质量评估。结果:全部获得随访,截至2013年1月,随访时间为2～104个月,中位随访时间为32个月,5年无瘤生存患者31例,无瘤生存率为60.7%。33例(31例无瘤生存,2例带瘤生存)长期生存患者的MSTS93评分为14～29分,平均20.6分,优良率为75.8%;SCL-90量表中人际关系、躯体化、焦虑、恐怖得分均高于常模(P<0.05);SF-36量表显示患者活力、总体健康、生理功能得分均较低。结论:DIA方案治疗原发性骨肉瘤切实可行,可使患者获得较高的长期生存率,但对患者心理行为和生存质量产生一定影响,提示我们需要加强骨肉瘤患者的心理支持,提高患者生存质量。

Background：With the development of the modern theory of oncology and the diagnosis and treatment of tumor,the purpose of osteosarcoma treatment can not be satisfied only by the improved survival rate,but also the improved quality of patients＇ life.The therapeutic principles have been transformed into seeking radical cure of the tumor,pursuing survival,and paying more attention to function maintenance and mental health at the same time.Objective：To observe the curative effects of DIA scheme（DDP,IFO,and ADM combined chemotherapy） in treating the primary osteosarcoma,as well as its effects on the psychological behavior and quality of life of the patients.Methods：From January 2004 to November 2011,51 patients（32 males and 19 females,aged from 6-51,mean age：18） with osteosarcoma were treated with the DIA scheme.Among them,48 cases were at the II B stage,and 3 were at the III stage.All patients were followed up,and their 5-year tumor-free survival rate was calculated.The limb functions of the long-term survivors were assessed according to the MSTS93 score,and their psychological behavior and quality of life were measured by Symptom Checklist 90（SCL-90） and Short Form 36（SF-36） respectively.Results：By January 2013,all patients had been followed up for a median period of 32 months（2-104 months）.There were 31 cases survived without tumor,the 5-year tumor-free survival rate was 60.7%.The MSTS93 scores of the 33 long-term survivors（31 survived without tumor and 2 survived with tumor） ranged from 14 to 29,with a mean score of 20.6 and an excellent-good rate of 75.8%;scores of the interpersonal relationship,somatization,anxiety,and fear in the SCL-90 were all higher than the norms（P0.05）;and scores of the patients＇ vitality,general health,physiological function in the SF-36 were all comparatively low.Conclusions：DIA scheme is a feasible treatment for primary osteosarcoma.It can enable the patients to have a higher long-term survival rate,but will affect the patients＇ psychological behavior and quality of life to a certain degree.It can be concluded that we should provide more psychological support to patients with osteosarcoma,and improve the quality of life of the patients.