Imran Hamayun, Enders Felicity, Krailo Mark, Sim Franklin, Okuno Scott, Hawkins Douglas, Neglia Joseph, Randall R Lor, Womer Richard, Mascarenhas Leo, Arndt Carola A S
University of South Alabama, 1504 Springhill Avenue, Room 5231, Mobile, AL 36604, USA.
J Bone Joint Surg Am. 2009 Mar 1;91(3):604-12. doi: 10.2106/JBJS.H.00449.
The dose intensity of chemotherapy has been described as affecting the outcome of the treatment of a number of different types of tumors. A delay in the resumption of chemotherapy after definitive surgery for the treatment of osteosarcoma can decrease the overall dose intensity. The goal of this study was to assess the prognostic significance of the time to resumption of chemotherapy after definitive surgery in patients with localized osteosarcoma in an extremity.
The relationships of the time between definitive surgery and resumption of chemotherapy with death and adverse events in 703 patients with a localized resectable osteosarcoma in an extremity (556 treated in the Children's Oncology Group [COG] Study [INT 0133] and 147 treated at five tertiary care cancer centers) were assessed with use of Cox proportional hazards models.
The twenty-fifth, fiftieth, and seventy-fifth percentiles of time from definitive surgery to resumption of chemotherapy were twelve, sixteen, and twenty-one days, respectively. Overall survival was poorer for patients who had had a delay of greater than twenty-one days before the resumption of chemotherapy compared with those who had had a shorter delay (hazard ratio = 1.57 [95% confidence interval = 1.04 to 2.36]; p = 0.03). Of seventy-one COG-study patients with postoperative complications, 32% (twenty-three) had a delay of more than twenty-one days before resumption of chemotherapy, but 20% (eighty-nine) of 444 patients with no complications had a similar delay.
In this retrospective analysis, increased time from the definitive surgery to the resumption of chemotherapy was found to be associated with an increased risk of death of patients with localized osteosarcoma in an extremity. Within the limitations of a retrospective study, the data indicate that it is best to resume chemotherapy within twenty-one days after definitive surgery. Surgeons, oncologists, patients, and those responsible for scheduling need to work together to ensure timely resumption of chemotherapy after surgery.
化疗剂量强度已被描述为会影响多种不同类型肿瘤的治疗结果。骨肉瘤根治性手术后化疗恢复的延迟会降低总体剂量强度。本研究的目的是评估肢体局限性骨肉瘤患者根治性手术后化疗恢复时间的预后意义。
采用Cox比例风险模型评估了703例肢体局限性可切除骨肉瘤患者（556例在儿童肿瘤学组[COG]研究[INT 0133]中接受治疗，147例在五个三级癌症中心接受治疗）根治性手术与化疗恢复之间的时间与死亡及不良事件的关系。
从根治性手术到化疗恢复时间的第25、50和75百分位数分别为12天、16天和21天。化疗恢复延迟超过21天的患者与延迟较短的患者相比，总生存期较差（风险比=1.57[95%置信区间=1.04至2.36]；p=0.03）。在71例有术后并发症的COG研究患者中，32%（23例）化疗恢复延迟超过21天，但在444例无并发症的患者中有20%（89例）有类似延迟。
在这项回顾性分析中，发现从根治性手术到化疗恢复的时间增加与肢体局限性骨肉瘤患者死亡风险增加相关。在回顾性研究的局限性内，数据表明最好在根治性手术后21天内恢复化疗。外科医生、肿瘤学家、患者以及负责安排日程的人员需要共同努力，以确保术后及时恢复化疗。
