经皮下植入式给药系统行动脉内化疗治疗骨肉瘤的化疗反应分析。

Chemotherapy response analysis for osteosarcom with intra-arterial chemotherapy by subcutaneous implantable delivery system.

机构信息

Department of Orthopedics, The Affiliated Hospital of Academy of Military Medical Sciences, PLA 307th Hospital, Beijing 100071, China.

出版信息

Pathol Oncol Res. 2011 Dec;17(4):947-53. doi: 10.1007/s12253-011-9408-5. Epub 2011 Jun 30.

DOI:10.1007/s12253-011-9408-5

PMID:21713601

Abstract

To summarize the experience in intraarterial neoadjuvant chemotherapy for extremity osteosarcoma. Between January 2002 and December 2007,111 patients with stage IIB extremity osteosarcoma received preoperative intraarterial therapy with subcutaneous implantation of chemotherapy pump as well as en bloc resection, and postoperative adjuvant chemotherapy. There were 63 males and 48 females with an average age of 18 (range, 14 ~ 39 years). The time from symptom onset to hospitalization varied from several days to 6 months. The induction chemotherapy regimen includes: epirubicin [50 ~ 70 mg/m(2) by 4-hour intraarterial infusion/day for 3 day] and cisplatin [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 two cycles induction chemotherapy was set to nonstandard chemotherapy group and 87 cases received three to six cycles induction chemotherapy set to standard chemotherapy group. The number of preoperative chemotherapy-cycles of standard chemotherapy group depends on the clinical and radiographic evaluation of chemotherapy efficacy. Median follow-up time was 28(8 ~ 48) months. The rate of limb preservation surgery was 89.53% (77/86) in standard chemotherapy group,and was 37.5% (9/24) in nonstandard chemotherapy group. Kaplan-Meier survival analysis showed that the 3-year overall survival rate and disease free survival rate of all the 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 metastasis rate (66.67%, 16.09%, P = 0.0000) and local recurrence rate (58.33%, 13.79%, P = 0.0000) between nonstandard chemotherapy group and standard chemotherapy group. Standard intraarterial neo-adjuvant chemotherapy was more effective than nonstandard intraarterial induction chemotherapy to stage IIB extremity osteosarcoma.

摘要

总结肢体骨肉瘤动脉内新辅助化疗的经验。2002 年 1 月至 2007 年 12 月，111 例 IIB 期肢体骨肉瘤患者接受术前动脉内治疗，包括皮下植入化疗泵和整块切除术，以及术后辅助化疗。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数天到 6 个月不等。诱导化疗方案包括：表柔比星[50~~70mg/m(2)，4 小时动脉内输注/天，共 3 天]和顺铂[100~~120mg/m(2)，2 小时动脉内输注/天，共 3 天]，每 2~~3 周重复一次。其中 24 例仅接受 2 个周期的诱导化疗，设为非标准化疗组，87 例接受 3~~6 个周期的诱导化疗，设为标准化疗组。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。标准化疗组中位随访时间为 28（8~~48）个月。标准化疗组保留肢体手术率为 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=0.000）和局部复发率（58.33%，13.79%，P=0.000）均有显著差异。非标准动脉内诱导化疗与标准动脉内新辅助化疗相比，对 IIB 期肢体骨肉瘤更有效。