Ferrari Stefano, Palmerini Emanuela, Staals Eric L, Mercuri Mario, Franco Bertoni, Picci Piero, Bacci Gaetano
Sezione di Chemioterapia, dei Tumori dell' Apparato Locomotore, Istituto Ortopedico Rizzoli, via Pupilli 1, Bologna, 40136, Italy.
Cancer Treat Res. 2009;152:275-87. doi: 10.1007/978-1-4419-0284-9_14.
The Bone Tumor Center of the "Istituto Ortopedico Rizzoli" was established in 1955 with the aim of studying and treating the musculoskeletal tumors. Between 1959 and 2006, 1245 patients with high grade nonmetastatic osteosarcoma of the extremity were treated at our Institute. Most of them were enrolled in study protocols. In the "prechemotherapy era", the cure rate was 11%, with an amputation rate of 90%. Our first experience with adjuvant chemotherapy was in 1972. A total of 223 patients received adjuvant chemotherapy, with a disease-free survival (DFS) ranging from 45% to 53%, according to the chemotherapy protocol used. With the introduction of neoadjuvant chemotherapy, the resection rate increased and reached 94%, when high dose fosfamide was added to standard doses of methotrexate, cisplatin, and adriamycin. In the last few years, the results of treatment of nonmetastatic osteosarcoma of the extremity have reached a plateau (64% five-year DFS), and strategies of dose intensification are not able to improve the prognosis. Not only new active drugs, but also different approaches to the disease, are needed. In this regard, we are now investigating tumor microenvironment-targeted agents and chemotherapy protocols based on prospective biological stratification of patients. Collaborative projects with international groups and institutions are crucial for this rare disease.
“里佐利骨科研究所”的骨肿瘤中心成立于1955年，旨在研究和治疗肌肉骨骼肿瘤。1959年至2006年期间，我们研究所共治疗了1245例肢体高级别非转移性骨肉瘤患者。他们中的大多数人参加了研究方案。在“化疗前时代”，治愈率为11%，截肢率为90%。我们首次使用辅助化疗是在1972年。根据所使用的化疗方案，共有223例患者接受了辅助化疗，无病生存率（DFS）在45%至53%之间。随着新辅助化疗的引入，当在标准剂量的甲氨蝶呤、顺铂和阿霉素中加入高剂量磷酰胺时，切除率提高并达到了94%。在过去几年中，肢体非转移性骨肉瘤的治疗结果已达到一个平台期（五年DFS为64%），剂量强化策略无法改善预后。不仅需要新的活性药物，还需要针对该疾病的不同方法。在这方面，我们目前正在研究基于患者前瞻性生物学分层的肿瘤微环境靶向药物和化疗方案。与国际团体和机构的合作项目对于这种罕见疾病至关重要。
