晚期骨肉瘤的二线化疗疗效观察

Efficacy of second-line chemotherapy for advanced osteosarcoma

目的:观察培美曲塞联合顺铂治疗晚期复发转移性骨肉瘤的有效性和安全性。方法:收集2009年1月至2014年12月期间我们观察的30例一线化疗失败的出现转移的晚期骨肉瘤患者,行培美曲塞500 mg/m^2,静脉滴注d1;顺铂75~100 mg/m^2静脉滴注d_1~d_3,21天为1周期;化疗2个周期后按照RECIST标准评价客观疗效;如达到PR及SD的患者继续行原方案化疗2周期。结果:30例患者均完成化疗,可评价疗效。完全缓解0例(CR),部分缓解(PR)5例,疾病稳定(SD)11例,疾病进展(PD)14例;有效率(RR)为16.7%,病控制率(DCR)为53.3%,中位无进展生存时间为8.0个月,中位生存时间为15.8个月,主要不良反应为限制性骨髓抑制,无患者出现肝肾功能不全和过敏反应,2例出现4级中性粒细胞及血小板减少。结论:培美曲塞联合顺铂方案二线治疗晚期复发转移性骨肉瘤疗效肯定,毒副反应可以接受。

Objective：To investigate the efficacy and side effects of pemetrexed combined with cisplatin in treatment of advanced recurrent and metastasis osteosarcoma.Methods：From January 2009 to December 2014,30 osteosarcoma patients with advanced recurrent and metastasis osteosarcoma were prescribed cisplatin （75～100 mg/m^2,d1～d3） combined with pemetrexed （500 mg/m^2,d1） as the second-line chemotherapy drugs,who failed in using first-line chemotherapy drugs.21 days was a cycle,and the second cycle was implemented if results had reached PR and SD.Curative efficacy and adverse reactions of chemotherapy were evaluated after 2 cycles.Curative efficacy was evaluated by criterion RECIST 1.0 edition and side effects were recorded by criterion3.0 edition.Results：All patients completed treatment and could be evaluated.There were complete remission （CR） in no case,partial remission （PR） in 5 cases,stable disease （SD） in 11 cases,and progression of disease （PD） in 14 cases.The response rate （RR） was 16.7%,and disease control rate （DCR） was 53.3%.During follow-up 2 patients died.The median progression free survival time was 8.0 months and the median overall survival time was 15.8 months.The major adverse reactions were limited myelosuppression during chemotherapy.There were no patients with renal dysfunction and allergic reaction,but grade 4 neutropenia and thrombocytopenia occurred in 2 cases.Conclusion：Pemetrexed combined with cisplatin regimen is effective as second-line chemotherapy drugs in therapy of advanced recurrent and metastasis osteosarcoma.The curative effect is affirmative and toxicity can be tolerated.