Tunn Per-Ulf, Reichardt Peter
Department of Surgery and Surgical Oncology, Campus Buch, Robert Rössle Hospital, elios Klinikum, Charité University Medicine Berlin, Germany.
Onkologie. 2007 May;30(5):228-32. doi: 10.1159/000100776. Epub 2007 Apr 24.
The clinical relevance of polychemotherapy in osteosarcoma is undisputed and well proven. In this retrospective study we report the results of chemotherapy treatment without high-dose methotrexate (HDMTX) for osteosarcoma.
Between 1986 and 1992, 53 patients with stage IIB extremity osteosarcoma received multimodal therapy (age: 6-36 years, median 17 years). All patients received neoadjuvant and adjuvant chemotherapy with adriamycin, cisplatin, cyclophosphamide, and vincristine without HDMTX. In 60.4%, tumor volume was < or =150 ml and in 39.6% >150 ml. Surgical modalities were distributed as follows: 71.7% of patients received limb-sparing surgery, 20.8% ablative surgery, and 7.5% rotationplasty. 35.8% of patients developed pulmonary metastases.
Overall survival (OAS) was 71.7% after 5 years and 67.2% after 10 years. Ten-year OAS was not observed with local recurrences; without local recurrence 10-year OAS was 74.2% (p = 0.002). Five-year OAS was 31.6% in patients who developed pulmonary metastases. Ten-year OAS was 71.1% and 61.1% when tumor volume was < or =150 ml and >150 ml, respectively (p = 0.445). Ten-year OAS was 73.5% in responders to preoperative chemotherapy; in poor responders 62.1% (p = 0.353). Event-free 10-year survival was 70.8% in responders and 48.3% in poor responders (p = 0.099).
Compared to treatment protocols including HDMTX similar survival rates were achieved.
多药联合化疗在骨肉瘤治疗中的临床相关性已得到充分证实且无可争议。在这项回顾性研究中，我们报告了骨肉瘤患者不使用大剂量甲氨蝶呤（HDMTX）的化疗治疗结果。
1986年至1992年间，53例IIB期肢体骨肉瘤患者接受了多模式治疗（年龄6至36岁，中位年龄17岁）。所有患者均接受了阿霉素、顺铂、环磷酰胺和长春新碱的新辅助化疗和辅助化疗，未使用HDMTX。60.4%的患者肿瘤体积≤150 ml，39.6%的患者肿瘤体积>150 ml。手术方式分布如下：71.7%的患者接受保肢手术，20.8%的患者接受根治性手术，7.5%的患者接受旋转成形术。35.8%的患者发生肺转移。
5年总生存率（OAS）为71.7%，10年为67.2%。局部复发患者未观察到10年OAS；无局部复发患者10年OAS为74.2%（p = 0.002）。发生肺转移的患者5年OAS为31.6%。肿瘤体积≤150 ml和>150 ml的患者10年OAS分别为71.1%和61.1%（p = 0.445）。术前化疗有反应者10年OAS为73.5%；反应不佳者为62.1%（p = 0.353）。有反应者10年无事件生存率为70.8%，反应不佳者为48.3%（p =
