Benjamin Robert S, Wagner Michael J, Livingston J Andrew, Ravi Vinod, Patel Shreyaskumar R
From the Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
Am Soc Clin Oncol Educ Book. 2015:e656-60. doi: 10.14694/EdBook_AM.2015.35.e656.
Increasing age is an adverse prognostic factor in the treatment of primary bone tumors. There are few published data on treatment of primary bone tumors in adults. This paper presents data from the Department of Sarcoma Medical Oncology at The University of Texas MD Anderson Cancer Center, summarizing our treatment results. To treat primary osteosarcoma, we used 90 mg/m2 of doxorubicin as a continuous intravenous infusion over 48 to 96 hours and 120 to 160 mg/m2 of cisplatin intravenously or intra-arterially. Initially, we found a marked difference in postoperative continuous disease-free survival (CDFS) between those with 90% or greater (i.e., good response) tumor necrosis and those with less than 90% (i.e., poor response) tumor necrosis. The sequential addition of high-dose methotrexate and ifosfamide to patients with poorly responding disease improved their CDFS to that of patients with good response. Older patients and those who have tumors with variant histology have inferior outcomes. Evaluation of subsequent patients revealed similar outcomes for those with good or poor response to induction therapy, supporting our practice of adaptation of postoperative chemotherapy to the results of preoperative chemotherapy. PET-CT is the best imaging modality to screen for a response with tumors inside bone. To treat Ewing sarcoma, we have employed 2 mg of vincristine, 75 to 90 mg/m2 of doxorubicin as a 72-hour infusion, and 2.5 g/m2 of ifosfamide over 3 hours daily for 4 doses (i.e., vincristine, doxorubicin, and ifosfamide [VAI]). Preliminary analysis indicates a higher CDFS when adjusted for patient age than seen with the standard alternating regimen used in pediatrics. A screening MRI of the pelvis and spine can detect subtle metastatic disease in bone or bone marrow that is missed by other imaging modalities or blind biopsy. Chondrosarcoma is treated surgically or on investigational protocols. Giant cell tumor of bone is usually managed surgically, but multiple options exist for medical treatment, and therapy is individualized with embolization, denosumab, and interferon.
年龄增长是原发性骨肿瘤治疗中的一个不良预后因素。关于成人原发性骨肿瘤治疗的已发表数据较少。本文展示了得克萨斯大学MD安德森癌症中心肉瘤医学肿瘤科的数据，总结了我们的治疗结果。治疗原发性骨肉瘤时，我们使用90mg/m²的阿霉素持续静脉输注48至96小时，以及120至160mg/m²的顺铂静脉或动脉内给药。最初，我们发现肿瘤坏死率达90%或更高（即反应良好）的患者与肿瘤坏死率低于90%（即反应不佳）的患者术后无病持续生存期（CDFS）存在显著差异。对反应不佳的患者序贯添加高剂量甲氨蝶呤和异环磷酰胺后，其CDFS提高到了反应良好患者的水平。老年患者以及组织学类型变异的肿瘤患者预后较差。对后续患者的评估显示，诱导治疗反应良好或不佳的患者预后相似，这支持了我们根据术前化疗结果调整术后化疗的做法。PET-CT是筛查骨内肿瘤反应的最佳影像学检查方法。治疗尤因肉瘤时，我们采用了2mg长春新碱、75至90mg/m²阿霉素静脉输注72小时，以及2.5g/m²异环磷酰胺每日3小时共4剂（即长春新碱、阿霉素和异环磷酰胺[VAI]）。初步分析表明，经患者年龄校正后，CDFS高于儿科使用的标准交替方案。骨盆和脊柱的筛查MRI可检测出其他影像学检查或盲目活检遗漏的骨或骨髓中的微小转移病灶。软骨肉瘤采用手术治疗或按照研究方案治疗。骨巨细胞瘤通常采用手术治疗，但药物治疗有多种选择，治疗方法根据栓塞、地诺单抗和干扰素进行个体化。
