不同新辅助化疗方案治疗骨肉瘤的近期疗效对比

Short-term efficacy of different neoadjuvant chemotherapy in treatment of osteosarcoma

目的探讨不同新辅助化疗方案治疗骨肉瘤的近期疗效。方法收集49例接受新辅助化疗的骨肉瘤患者的病历资料,其中接受大剂量氨甲蝶呤+多柔比星+顺铂+异环磷酰胺(MAPI)方案20例,大剂量氨甲蝶呤+多柔比星+顺铂(MAP)方案23例,多柔比星+顺铂+异环磷酰胺(DIA)方案6例,比较3组患者的疗效及不良反应发生情况。结果49例患者均完成了新辅助疗程,且进行了随访,术后病理学检查肿瘤组织坏死率≥90%的患者共41例,MAPI方案占36.6%(15/41),MAP方案占53.7%(22/41),DIA方案占9.8%(4/41),差异有统计学意义(P﹤0.05)。采用各方案化疗的患者保肢率均为100%。采用各方案化疗的患者疗效比较,差异无统计学意义(P﹥0.05)。接受MAPI方案化疗的患者恶心呕吐及骨髓抑制发生率均高于其他方案。结论MAP方案术后肿瘤组织坏死率高于其他方案,且在安全性方面优于其他方案,耐受性好,不良反应小。因此,临床若有条件进行氨甲蝶呤的血药浓度测定,则建议MAP方案作为骨肉瘤新辅助化疗的优选方案。

Objective To explore the short-term efficacy of different neoadjuvant chemotherapy for osteosarcoma.Method Medical records of 49 osteosarcoma patients treated with neoadjuvant chemotherapy were collected,including 20 cases receiving high-dose methotrexate+doxorubicin+cisplatin+ifosfamide(MAPI),23 cases receiving high-dose methotrexate+doxorubicin+cisplatin(MAP),and 6 cases receiving doxorubicin+cisplatin+ifosfamide(DIA),the efficacy and adverse reactions were compared.Result All the 49 patients completed the neoadjuvant course of treatment and were followed up.There were 41 patients with tumor necrosis rate≥90% after pathological examination,in which the MAPI accounted for 36.6%(15/41),MAP accounted for 53.7%(22/41)and DIA accounted for 9.8%(4/41)(P<0.05).The limb salvage rate was 100%.There was no significant difference for the efficacy of patients treated with different chemotherapy schemes(P>0.05).The incidence of nausea,vomiting and myelosuppression in patients receiving MAPI chemotherapy was higher than that of other chemotherapy regimens.Conclusion The tumor necrosis rate of MAP is higher than other treatments,with superior safety,good tolerance and less adverse reactions.Therefore,it is suggested that MAP should be the optimal treatment for neoadjuvant chemotherapy of osteosarcoma if it is possible to clinically determine the blood concentration of methotrexate.