Pratt C, Shanks E, Hustu O, Rivera G, Smith J, Kumar A P
Cancer. 1977 Jan;39(1):51-7. doi: 10.1002/1097-0142(197701)39:1<51::aid-cncr2820390110>3.0.co;2-t.
Results of treatment for osteosarcoma of the extremity have been poor with metastases usually causing death within 2 years following diagnosis. Because of the great risk of development of metastases, 20 patients have received adjuvant chemotherapy with Adriamycin, cyclophosphamide and high-dose methotrexate-leucovorin rescue for up to 12 months following amputation for osteosarcoma. Sixteen of these patients are surviving; 11 are free of evident tumor from 6 to 34 months following amputation. Five patients were found to have pulmonary metastases while receiving chemotherapy and three patients developed metastases following completion of chemotherapy. One patient died following her third treatment with high-dose methotrexate-leucorovin rescue. Other toxicity included nausea, vomiting, mucosal ulcerations, infections, hematologic abnormalities, changes in kidney and liver functions tests, and minor coagulation abnormalities. The natural history of osteosarcoma may have been modified by the use of these agents for periods exceeding the median time to predicted detection of pulmonary metastases. Microscopic metastases of some patients were eradicated by this adjuvant chemotherapy. For patients who developed metastases, these metastases were delayed in their time of detection and in their number at the time of detection.
肢体骨肉瘤的治疗结果一直很差，转移通常会导致患者在诊断后2年内死亡。由于发生转移的风险很大，20例骨肉瘤患者在截肢后接受了阿霉素、环磷酰胺和大剂量甲氨蝶呤-亚叶酸钙解救的辅助化疗，持续时间长达12个月。其中16例患者存活；11例在截肢后6至34个月无明显肿瘤。5例患者在接受化疗时发现有肺转移，3例患者在化疗结束后发生转移。1例患者在第三次接受大剂量甲氨蝶呤-亚叶酸钙解救治疗后死亡。其他毒性反应包括恶心、呕吐、黏膜溃疡、感染、血液学异常、肾功能和肝功能检查结果改变以及轻微凝血异常。使用这些药物的时间超过了预测发现肺转移的中位时间，可能改变了骨肉瘤的自然病程。一些患者的微小转移灶通过这种辅助化疗得以根除。对于发生转移的患者，这些转移灶的检测时间延迟，且检测时转移灶数量减少。
