Longhi A, Fabbri N, Donati D, Capanna R, Briccoli A, Biagini R, Bernini G, Ferrari S, Versari M, Bacci G
Department of Chemotherapy, Istituto Ortopedico Rizzoli, Bologna, Italy.
J Chemother. 2001 Jun;13(3):324-30. doi: 10.1179/joc.2001.13.3.324.
Between January 1995 and December 1999, 11 patients with synchronous multifocal osteosarcoma (SMO) received neoadjuvant treatment with high-dose methotrexate, cisplatinum, Adriamycin, and ifosfamide. After primary chemotherapy in 4 patients who had only two bone localizations, it was possible to treat all tumor foci locally. The remaining patients, with more than three bones involved, were treated surgically only in 3 cases at the primary site, while secondary lesions did not receive any treatment. The final results of our study were disappointing. All patients died of the tumor 6 to 24 months after the beginning of treatment (mean 11.9 months). Nevertheless, the survival time of the 4 patients with locally treated lesions was significantly longer than the one of 7 patients in whom the secondary lesions were not locally treated (18.2 vs 9.1 months; P<0.008). It should be noted that those patients simultaneously operated on two sites, the response to chemotherapy of "primary" and "secondary" lesions was always similar. This homogeneity supports the thesis that in synchronous multifocal osteosarcoma the tumors are not multicentric in origin but represent bone-to-bone metastases from a monocentric tumor.
1995年1月至1999年12月期间，11例同步多灶性骨肉瘤（SMO）患者接受了大剂量甲氨蝶呤、顺铂、阿霉素和异环磷酰胺的新辅助治疗。4例仅有两个骨病灶的患者在接受初次化疗后，有可能对所有肿瘤病灶进行局部治疗。其余累及三个以上骨骼的患者，仅3例在原发部位接受了手术治疗，而继发灶未接受任何治疗。我们研究的最终结果令人失望。所有患者在治疗开始后6至24个月死于肿瘤（平均11.9个月）。然而，4例局部治疗病灶患者的生存时间明显长于7例未对继发灶进行局部治疗患者的生存时间（18.2个月对9.1个月；P<0.008）。应当指出，那些同时在两个部位进行手术的患者，“原发”和“继发”病灶对化疗的反应总是相似的。这种一致性支持了这样一种观点，即在同步多灶性骨肉瘤中，肿瘤并非起源于多中心，而是代表来自单中心肿瘤的骨对骨转移。
