骨肉瘤治疗中化疗的作用

Role of Chemotherapy in Treatment of Osteosarcoma

目的 初步评价骨肉瘤术后化疗、术前介入化疗 +术后化疗、新辅助化疗 3种方法的远期疗效。方法 1989- 1999年入院手术的 6 5例ⅡB期肢体骨肉瘤患者进行回顾性分析。化疗方法 :单纯术后化疗 31例 ,术前介入化疗 +术后化疗 16例 ,新辅助化疗 5例 ,未作化疗 13例。手术方法 :保肢手术 36例 ,截肢术 2 9例。所有病例经过 3～ 13年随访 ,平均 7.6年。结果 6 5例总 3年生存率为 4 1.5 % ,其中化疗组 4 8.1% ,非化疗组15 .4 % ,有显著性差异 ;肿瘤复发率也有显著差异 (13.5 %∶38.5 8% )。介入化疗组与单纯术后化疗组比较 ,术后复发明显降低 ,但远期生存率无显著差异。新辅助化疗初步评价患者无瘤生存率为 6 0 %。结论 骨肉瘤治疗模式应以全身化疗为核心。新辅助化疗可提高无瘤生存率 ,介入化疗对降低肿瘤复发有益 ,两种手段应相结合。

Purpose: To evaluate the long-term results of surgery combined with postoperative adjuvant chemotherapy, preoperative interventional chemotherapy with postoperative chemotherapy and neo-adjuvant chemotherapy on primary osteosarcoma of extremity. Methods: From 1989 to 1999, 65 patients aging from 11 to 55 years with the diagnosis of II B extremity osteosarcoma were treated with definitive surgery and various chemotherapy regimens. Thirty-eight of them were male and twenty-seven were female. The chemotherapy regimens included postoperative adjuvant chemotherapy in 31 cases, preoperative interventional chemotherapy with postoperative chemotherapy in 16 cases and neo-adjuvant chemotherapy in 5 caseses. 13 patients underwent surgery with non-chemotherapy. The 36 cases of limb salvage procedures were of wide or radical resections. Amputations were performed on 29 patients. The patients were followed-up for 3 to 13 years(mean seven years and six months). Results: Of 65 cases, 27 (41.5%) belonged to disease-free survival(DFS) at 3 years after operation. The 3 years DFS rate is 48.1% in chemotherapy group and 15.4% in non-chenotherapy group(P < 0.05). Local recurrence rate of two groups is 13.5% and 38.5(P < 0.05). Compared with postoperative adjuvant chemotherapy group, the combined interventional chemotherapy reduced recurrence rate but did not dramatically improved DFS rate. The primary result of DFS rate in neo-adjuvant chemotherapy group is 60%. Conclusions: Therapy principle of osteosarcoma should focus on systemic chemotyerapy. Neo-adjuvant chemotherapy and interventional chemotherapy should be combined organically during the therapy of osteosarcoma because the former can improve DFS rate and the latter reduce recurrence rate.