Rosen G, Murphy M L, Huvos A G, Gutierrez M, Marcove R C
Cancer. 1976 Jan;37(1):1-11. doi: 10.1002/1097-0142(197601)37:1<1::aid-cncr2820370102>3.0.co;2-3.
In an attempt to shrink primary osteogenic sarcoma and allow complete surgical removal of the primary tumor, without amputating the involved limb, intensive preoperative chemotherapy with high dose methotrexate (HDMTX) with citrovorum factor rescue (CFR) and adriamycin (ADR) was initiated in 20 patients with biopsy-proven primary osteogenic sarcoma of the distal femur (15 patients) and proximal tibia (five patients). Following intensive chemotherapy, en bloc resection of the primary tumor with prosthetic replacement of the involved bone was planned. After surgery, adjuvant chemotherapy, consisting of HDMTX with CFR, ADR, and high dose cyclophosphamide was given sequentially for 1 year. Of 20 patients with primary osteogenic sarcoma (two with evidence of pulmonary metastases), 18 had primary tumors that could be clinically measured. Of these 18, 17 demonstrated a decrease in the size of primary tumor prior to surgery, while on chemotherapy. To date, 12 of these patients with osteogenic sarcoma of the distal femur have had total femur and knee joint replacement, and three patients with osteogenic sarcoma of the proximal tibia have had total knee replacement. In all 15 patients, surgical margins were grossly and microscopically free of tumor. There has been no evidence of soft tissue recurrence in any of the 15 patients who have undergone surgery for from 2 to 15 months postoperatively. These preliminary results indicate that with the use of aggressive chemotherapy, it is possible to demonstrate objective tumor regression in primary osteogenic sarcoma, allowing the surgeon to perform en bloc resection of tumor and prosthetic replacement of the involved bone. Although the limb is preserved, it is important to stress that extensive surgery yielding tumor-free margins is performed. The ultimate evaluation of this approach to the treatment of primary osteogenic sarcoma awaits longer observation, to determine limb function and the continued disease-free status, once adjuvant chemotherapy is discontinued.
为了缩小原发性骨肉瘤的体积，在不截肢的情况下实现对原发性肿瘤的完整手术切除，对20例经活检证实为股骨远端（15例）和胫骨近端（5例）原发性骨肉瘤的患者，开始采用大剂量甲氨蝶呤（HDMTX）联合亚叶酸钙解救（CFR）及阿霉素（ADR）进行强化术前化疗。强化化疗后，计划对原发性肿瘤进行整块切除并对受累骨进行假体置换。术后，依次给予由HDMTX联合CFR、ADR及大剂量环磷酰胺组成的辅助化疗，为期1年。在20例原发性骨肉瘤患者中（2例有肺转移证据），18例原发性肿瘤可进行临床测量。在这18例患者中，17例在化疗期间术前原发性肿瘤大小减小。迄今为止，12例股骨远端骨肉瘤患者已接受全股骨和膝关节置换，3例胫骨近端骨肉瘤患者已接受全膝关节置换。在所有15例患者中，手术切缘在大体和显微镜下均无肿瘤。在术后2至15个月接受手术的15例患者中，均未发现软组织复发迹象。这些初步结果表明，通过积极化疗，原发性骨肉瘤有可能出现客观的肿瘤退缩，使外科医生能够对肿瘤进行整块切除并对受累骨进行假体置换。尽管保留了肢体，但必须强调的是，要进行能获得无瘤切缘的广泛手术。对于这种原发性骨肉瘤治疗方法的最终评估，有待更长时间的观察，以确定一旦辅助化疗停止后肢体功能及疾病持续无进展状态。
