[肢体骨肉瘤的动脉内新辅助化疗]

[Intraarterial neoadjuvant chemotherapy for extremity osteosarcoma].

作者信息

Liu Yao-sheng, Li Ding-feng, Liu Shu-bin, Cui Qiu

机构信息

Department of Orthopedics, PLA No. 307 Hospital, Beijing 100071, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2009 Nov 10;89(41):2915-9.

PMID:20137649

Abstract

OBJECTIVE

To summarize the experiences in intraarterial neoadjuvant chemotherapy for extremity osteosarcoma.

METHODS

Between January 2002 and December 2007, 111 patients with stage IIB extremity osteosarcoma received preoperative intraarterial chemotherapy after placing chemotherapy pump subcutaneously, en bloc resection and postoperative adjuvant chemotherapy. There were 63 males and 48 females with an average age of 18 years old (range: 14 - 39). The time from symptom onset to hospitalization varied from several days to 6 months. The induction chemotherapy regimen included epirubicin [50 - 70 mg/m(2) by 4-hour intraarterial infusion/day for 3 days] and epirubicin plus adriamycin [100 - 120 mg/m(2) by 2-hour intraarterial infusion/day for 3 days] repetitively every 2 - 3 weeks. Among which 24 cases only received 2 cycles of induction chemotherapy was assigned into the nonstandard chemotherapy group and 87 cases receiving 3 - 6 cycles of induction chemotherapy the standard chemotherapy group. The number of preoperative chemotherapeutical cycles of standard chemotherapy group depended on the clinical and radiographic evaluation of chemotherapy efficacy.

RESULTS

The median follow-up time was 28 (8 - 48) months. The rate of extremity preservation surgery was 89.53% (77/86) in the standard chemotherapy group and 37.5% (9/24) in the nonstandard chemotherapy group. Kaplan-Meier survival analysis showed that the 3-year overall survival rate and disease-free survival rate of all 111 cases were 68.3% and 65.9% respectively. There were significant differences in overall survival rate (38.9%, 80.0%, P = 0.000), disease-free survival rate (30.1%, 79.5%, P = 0.000), distant metastatic rate (66.67%, 16.09%, P = 0.0000) and local recurrence rate (58.33%, 13.79%, P = 0.0000) between two groups.

CONCLUSION

Standard intraarterial neo-adjuvant chemotherapy is more effective than nonstandard intraarterial induction chemotherapy to treat stage IIB extremity osteosarcoma.

摘要

目的

总结肢体骨肉瘤动脉内新辅助化疗的经验。

方法

2002年1月至2007年12月，111例IIB期肢体骨肉瘤患者在皮下置入化疗泵后接受术前动脉内化疗、整块切除及术后辅助化疗。其中男性63例，女性48例，平均年龄18岁（范围：14 - 39岁）。从症状出现到住院的时间从几天到6个月不等。诱导化疗方案包括表柔比星[50 - 70mg/m²，动脉内输注4小时/天，共3天]以及表柔比星加阿霉素[100 - 120mg/m²，动脉内输注2小时/天，共3天]，每2 - 3周重复一次。其中24例仅接受2个周期诱导化疗的患者被归入非标准化疗组，87例接受3 - 6个周期诱导化疗的患者被归入标准化疗组。标准化疗组术前化疗周期数取决于化疗疗效的临床和影像学评估。

结果

中位随访时间为28（8 - 48）个月。标准化疗组肢体保肢手术率为89.53%（77/86），非标准化疗组为37.5%（9/24）。Kaplan - Meier生存分析显示，111例患者的3年总生存率和无病生存率分别为68.3%和65.9%。两组在总生存率（38.9%，80.0%，P = 0.000）、无病生存率（30.1%，79.5%，P = 0.000）、远处转移率（66.67%，16.09%，P = 0.0000）和局部复发率（58.33%，13.79%，P = 0.0000）方面存在显著差异。