Bacci G, Avella M, Picci P, Dallari D, Malaguti C, Biagini R, Ruggieri P, Balladelli A, Ferrari S, Caldora P
Centro di Chemioterapia Oncologica, Istituto Ortopedico Rizzoli, Bologna, Italy.
Tumori. 1990 Dec 31;76(6):537-42. doi: 10.1177/030089169007600604.
Between March 1983 and September 1988, 22 patients with non-metastatic malignant fibrous histiocytoma MFH of bone of the extremities were treated with two regimens of neo-adjuvant chemotherapy successively activated. Preoperatively, the patients received moderate doses of methotrexate and cisplatinum-Regimen 1- or high dose methotrexate, cisplatinum and adriamycin-Regimen 2. Cisplatinum was delivered intraarteriously, the other drugs intravenously. Limb salvage surgery was performed in 20 patients, and 2 patients were amputated. The surgical margins were adequate (radical or wide) in 18 cases and inadequate (marginal) in 4. The histologic response to chemotherapy was good (90% or more tumor necrosis) in 8 patients. In both regimens postoperative chemotherapy was tailored according to the grade of necrosis determined by preoperative treatment on the primary tumor. At an average follow-up of 40 months (15-70), 15 patients (68%) remained continuously disease-free and 7 relapsed with metastases. No local recurrences were observed. Regimen 2 was slightly more effective than Regimen 1 in terms of good histologic response (5/10 vs 1/12) and continuous disease-free survival (8/10 vs 7/127). The results demonstrate that, as in osteosarcoma, in non-metastatic malignant fibrous histiocytoma of bone in the extremities a high percentage of patients can be cured with neoadjuvant chemotherapy and that in most of them limb sparing surgery is possible and safe.
1983年3月至1988年9月期间，22例四肢骨非转移性恶性纤维组织细胞瘤（MFH）患者先后接受了两种新辅助化疗方案治疗。术前，患者接受中等剂量甲氨蝶呤和顺铂（方案1）或高剂量甲氨蝶呤、顺铂和阿霉素（方案2）治疗。顺铂经动脉给药，其他药物经静脉给药。20例患者接受了保肢手术，2例患者接受了截肢手术。手术切缘充分（根治性或广泛性）的有18例，不充分（边缘性）的有4例。8例患者对化疗的组织学反应良好（肿瘤坏死率达90%或更高）。两种方案术后化疗均根据术前对原发肿瘤治疗所确定的坏死程度进行调整。平均随访40个月（15 - 70个月），15例患者（68%）持续无病生存，7例复发并发生转移。未观察到局部复发。在良好的组织学反应（5/10 vs 1/12）和持续无病生存方面（8/10 vs 7/12），方案2比方案1稍有效。结果表明，与骨肉瘤一样，四肢骨非转移性恶性纤维组织细胞瘤患者中，高比例患者可通过新辅助化疗治愈，且大多数患者可行保肢手术且安全。
