Kempf R A, Irwin L E, Menendez L, Chandrasoma P, Groshen S, Melbye W, Moore T, Pentecost M, Quinn M, Sapozink M
Department of Medicine, University of Southern California School of Medicine, Los Angeles 90033.
Cancer. 1991 Aug 15;68(4):738-43. doi: 10.1002/1097-0142(19910815)68:4<738::aid-cncr2820680413>3.0.co;2-j.
Preoperative therapy has been tested as part of limb salvage therapy for localized bone and soft tissue sarcoma of the extremities. The activity of cisplatin (CDDP) by intraarterial (IA) infusion was evaluated in 40 cases of which 36 were evaluable for response. All patients had high-grade sarcomas. All but 3 patients received 3 or 4 courses (24 patients received 4 courses) of CDDP at a dosage of 120 to 150 mg/m2 given over 6 hours every 2 weeks by IA infusion. Patients younger than 18 years of age received the higher dose of CDDP. Treatment was well tolerated with combination antiemetics. One patient experienced severe hearing loss with the first cycle of the higher CDDP dose. Pathologic evaluation of resected osteosarcoma showed a favorable response (90% or greater necrosis) in 8 of 20 evaluable cases and in 3 of 4 patients with malignant fibrous histiocytoma (MFH) of bone (without osteoid). In soft tissue sarcomas, minimal (50% to 89%) necrosis was seen in two of nine cases and none had 90% or greater necrosis. Patients received postoperative chemotherapy based on pathologic response, but the value of this postoperative adjuvant therapy requires further follow-up and is uncertain in this small study. IA CDDP can often cause significant tumor necrosis in patients with bone sarcomas, whereas soft tissue sarcomas are less sensitive to this therapy.
术前治疗已作为肢体挽救治疗的一部分，用于治疗四肢局限性骨肉瘤和软组织肉瘤。对40例患者进行了顺铂（CDDP）动脉内（IA）灌注活性评估，其中36例可评估反应。所有患者均为高级别肉瘤。除3例患者外，所有患者均接受了3或4个疗程（24例患者接受4个疗程）的CDDP治疗，剂量为120至150mg/m²，每2周通过IA灌注在6小时内给药。18岁以下患者接受更高剂量的CDDP。联合使用止吐药时，治疗耐受性良好。1例患者在接受首个更高剂量CDDP疗程时出现严重听力损失。对切除的骨肉瘤进行病理评估显示，20例可评估病例中有8例以及4例骨恶性纤维组织细胞瘤（MFH）（无类骨质）患者中有3例出现良好反应（坏死率达90%或更高）。在软组织肉瘤中，9例中有2例出现最小程度（50%至89%）坏死，无一例坏死率达90%或更高。患者根据病理反应接受术后化疗，但这种术后辅助治疗的价值需要进一步随访，且在这项小型研究中尚不确定。IA CDDP通常可使骨肉瘤患者出现显著的肿瘤坏死，而软组织肉瘤对这种治疗的敏感性较低。
