Ferrari Stefano, Bielack Stefan S, Smeland Sigbjørn, Longhi Alessandra, Egerer Gerlinde, Sundby Hall Kirsten, Donati Davide, Kevric Matthias, Brosjö Otte, Comandone Alessandro, Werner Mathias, Monge Odd, Palmerini Emanuela, Berdel Wolfgang E, Bjerkehagen Bodil, Paioli Anna, Lorenzen Sylvie, Eriksson Mikael, Gambarotti Marco, Tunn Per-Ulf, Jebsen Nina L, Cesari Marilena, von Kalle Thekla, Ferraresi Virginia, Schwarz Rudolf, Bertulli Rossella, Kasparek Anne-Katrin, Grignani Giovanni, Krasniqi Fatime, Sorg Benjamin, Hecker-Nolting Stefanie, Picci Piero, Reichardt Peter
1 Oncology Department, Istituto Ortopedico Rizzoli, Bologna - Italy.
2 Stuttgart Cancer Center, Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart Olgahospital, Stuttgart - Germany.
Tumori. 2018 Jan-Feb;104(1):30-36. doi: 10.5301/tj.5000696.
The EUROpean Bone Over 40 Sarcoma Study (EURO-B.O.S.S.) was the first prospective international study for patients 41-65 years old with high-grade bone sarcoma treated with an intensive chemotherapy regimen derived from protocols for younger patients with high-grade skeletal osteosarcoma.
Chemotherapy based on doxorubicin, cisplatin, ifosfamide, and methotrexate was suggested, but patients treated with other regimens at the investigators' choice were also eligible for the study.
The present report focuses on the subgroup of 218 patients with primary high-grade osteosarcoma. With a median follow-up of 47 months, the 5-year probability of overall survival (OS) was 66% in patients with localized disease and 22% in case of synchronous metastases. The 5-year OS in patients with localized disease was 29% in pelvic tumors, and 70% and 73% for extremity or craniofacial locations, respectively. In primary chemotherapy, tumor necrosis ≥90% was reported in 21% of the patients. There were no toxic deaths; however, hematological toxicity was considerable with 32% of patients experiencing 1 or more episodes of neutropenic fever. The incidence of nephrotoxicity and neurotoxicity (mainly peripheral) was 28% and 24%, respectively. After methotrexate, 23% of patients experienced delayed excretion, in 4 cases with nephrotoxicity.
In patients over 40 years of age with primary high-grade osteosarcoma, an aggressive approach with chemotherapy and surgery can offer the probability of survival similar to that achieved in younger patients. Chemotherapy-related toxicity is significant and generally higher than that reported in younger cohorts of osteosarcoma patients treated with more intensive regimens.
欧洲40岁以上骨肉瘤研究（EURO - B.O.S.S.）是第一项针对41 - 65岁高级别骨肉瘤患者的前瞻性国际研究，这些患者接受了源自年轻高级别骨肉瘤患者治疗方案的强化化疗方案。
建议采用基于阿霉素、顺铂、异环磷酰胺和甲氨蝶呤的化疗，但研究者选择使用其他方案治疗的患者也符合研究条件。
本报告重点关注218例原发性高级别骨肉瘤患者亚组。中位随访47个月，局限性疾病患者的5年总生存率（OS）为66%，同步转移患者为22%。盆腔肿瘤局限性疾病患者的5年OS为29%，肢体或颅面部肿瘤分别为70%和73%。在初始化疗中，21%的患者报告肿瘤坏死≥90%。无毒性死亡；然而，血液学毒性相当大，32%的患者经历1次或更多次中性粒细胞减少性发热发作。肾毒性和神经毒性（主要是外周神经毒性）的发生率分别为28%和24%。甲氨蝶呤治疗后，23%的患者出现排泄延迟，4例伴有肾毒性。
对于40岁以上原发性高级别骨肉瘤患者，积极的化疗和手术方法可提供与年轻患者相似的生存概率。化疗相关毒性显著，通常高于接受更强化方案治疗的年轻骨肉瘤患者队列报告的毒性。
