von Hochstetter A R
Department of Pathology, University Hospital, Zurich, Switzerland.
Virchows Arch A Pathol Anat Histopathol. 1990;417(1):5-8. doi: 10.1007/BF01600102.
In the treatment of osteosarcoma pre-operative chemotherapy has assumed considerable importance in helping improve survival, and enabling limb-sparing procedures. The quantitative assessment of tumour necrosis in the resected specimen by morphological means has become a significant step in judging therapeutic response and in helping determine post-operative management. Different systems of grading tumour regression have been proposed. Little is known, however, about the morphology or degree of spontaneous necrosis in osteosarcomas, in particular to what extent necrosis can be considered to be due to cytotoxic treatment. For this purpose, 13 osteosarcomas, taken from patients treated by surgery alone, were examined by the same method we routinely employ in assessing chemotherapeutic response. The results demonstrate that the extent of spontaneous necrosis does not approach that achieved in response to chemotherapy. Sub-total necrosis may be due to spontaneous regression, inadequate therapeutic response, or to a combination of both. Hence, only two categories of response, good and poor, appear relevant and these terms should be used in preference to good, intermediate and poor.
在骨肉瘤的治疗中，术前化疗对于提高生存率以及实施保肢手术起着相当重要的作用。通过形态学方法对切除标本中的肿瘤坏死进行定量评估，已成为判断治疗反应及确定术后管理的重要步骤。人们提出了不同的肿瘤消退分级系统。然而，对于骨肉瘤的自发坏死形态或程度，尤其是坏死在多大程度上可被认为是由细胞毒性治疗所致，了解甚少。为此，我们采用在评估化疗反应时常规使用的相同方法，对13例仅接受手术治疗的患者的骨肉瘤进行了检查。结果表明，自发坏死的程度不及化疗所达到的程度。次全坏死可能是由于自发消退、治疗反应不足或两者兼而有之。因此，似乎只有良好和差这两类反应是相关的，并且应优先使用这两个术语，而不是良好、中等和差。
