Michelagnoli M P, Lewis I J, Gattamaneni H R, Bailey C C, Lashford L S
Paediatric Haematology and Oncology Unit, St James University Hospital, Leeds, UK.
Br J Cancer. 1999 Mar;79(7-8):1174-8. doi: 10.1038/sj.bjc.6690187.
Fifteen patients with relapsed osteosarcoma were treated with an intensive combination chemotherapy schedule. Ifosfamide 2.5 g m(-2) daily and etoposide 150 mg m(-2) daily coincidentally for 3 days and high-dose methotrexate 8 g m(-2) (with folinic acid rescue) on days 10-14 in a planned 21 -day cycle. Feasibility, toxicity and response to this alternative combination for the treatment of relapsed osteosarcoma was assessed. There were 98 evaluable cycles for toxicity and tolerability. The majority of cycles were well tolerated. Haematological toxicity of grade 3/4 (common toxicity criteria) was seen in all courses. Renal tubular loss of electrolytes, particularly magnesium, occurred in 71% of cycles. Thirteen per cent of cycles were repeated within 21 days and 61% within 28 days. In the thirteen patients evaluable for response, a partial response rate of 31% was seen after two cycles. However, patients with stable disease continued on therapy, and an overall consequent response rate of 62% was observed. Four patients were alive with no evidence of disease at 8-74 months. Three are alive with disease (at 8-19 months). There were six deaths, all disease related. This regimen exhibits an encouraging response rate in a group of children with poor prognosis disease, with a tolerable toxicity profile.
15例复发性骨肉瘤患者接受了强化联合化疗方案治疗。异环磷酰胺每日2.5 g/m²，依托泊苷每日150 mg/m²，同时给药3天，在计划的21天周期中的第10 - 14天给予高剂量甲氨蝶呤8 g/m²（亚叶酸钙解救）。评估了这种替代联合方案治疗复发性骨肉瘤的可行性、毒性和反应。共有98个可评估毒性和耐受性的周期。大多数周期耐受性良好。所有疗程均出现3/4级血液学毒性（通用毒性标准）。71%的周期出现肾小管电解质丢失，尤其是镁。13%的周期在21天内重复，61%在28天内重复。在可评估反应的13例患者中，两个周期后部分缓解率为31%。然而，疾病稳定的患者继续接受治疗，随后观察到总体缓解率为62%。4例患者在8 - 74个月时无疾病证据存活。3例患者带瘤存活（8 - 19个月）。有6例死亡，均与疾病相关。该方案在一组预后不良的儿童患者中显示出令人鼓舞的缓解率，且毒性特征可耐受。
