Stephens F O, Tattersall M H, Marsden W, Waugh R C, Green D, McCarthy S W
Cancer. 1987 Aug 15;60(4):724-35. doi: 10.1002/1097-0142(19870815)60:4<724::aid-cncr2820600404>3.0.co;2-1.
Eight patients who had large sarcomas in the hip, thigh, or shoulder girdle have been described. Three had osteogenic sarcomas, and one each had Ewing's sarcoma, biphasic synovial sarcoma, pleomorphic liposarcoma, undifferentiated spindling sarcoma, and malignant fibrous histiocytoma. All eight tumors showed evidence of regression after intraarterial infusion of cisplatin and Adriamycin (doxorubicin) given over 48 hours at 3-week intervals, for a total of between three and seven courses. Tru-cut needle biopsy specimens of five of the lesions were normal after chemotherapy. However, after resection of the regressed fibrotic tumor in seven of the patients, four contained foci of probably viable malignant cells. These cell foci were intraosseous in three cases and in the wall of a cyst in one case. In the remaining case, tumor in the distribution of the infused artery regressed, but tumor in a region supplied by an artery that was not infused continued to enlarge. In one patient with osteogenic sarcoma in the pelvis, despite a good response to intraarterial chemotherapy that was followed by surgical resection and radiotherapy, tumor recurred in an adjacent area in tissues supplied by an artery not infused. A hindquarter amputation subsequently was required. With the exception of the two cases in which adequate tumor arterial infusion was not achieved, local primary tumor control was accomplished by intraarterial infusion chemotherapy followed by local resection or radiotherapy and local resection in all patients. Four patients are well without evidence of residual or metastatic sarcoma 3.5 years after presentation in the case of an osteogenic sarcoma of shoulder, 2.5 years after presentation in the case of a large pleomorphic liposarcoma of thigh and groin, 20 months after presentation in the case of lower-thigh malignant fibrous histiocytoma, and 1 year after presentation in a child with an osteogenic sarcoma of lower femur.
本文描述了8例在髋部、大腿或肩胛带处患有大型肉瘤的患者。其中3例为骨肉瘤，1例分别为尤因肉瘤、双相滑膜肉瘤、多形性脂肪肉瘤、未分化梭形细胞肉瘤和恶性纤维组织细胞瘤。所有8例肿瘤在以顺铂和阿霉素（多柔比星）进行动脉内灌注后均显示出消退迹象，灌注在48小时内进行，每3周一次，共进行3至7个疗程。化疗后，5个病变的粗针活检标本恢复正常。然而，在7例患者切除消退的纤维化肿瘤后，4例含有可能存活的恶性细胞灶。这些细胞灶在3例中位于骨内，1例位于囊肿壁内。在其余病例中，灌注动脉分布区域的肿瘤消退，但未灌注动脉供应区域的肿瘤继续增大。1例骨盆骨肉瘤患者，尽管对动脉内化疗反应良好，随后进行了手术切除和放疗，但在未灌注动脉供应的相邻组织区域肿瘤复发。随后需要进行后肢截肢。除了2例未实现充分肿瘤动脉灌注的病例外，所有患者均通过动脉内灌注化疗，随后进行局部切除或放疗以及局部切除，实现了局部原发性肿瘤的控制。4例患者情况良好，在出现肩部骨肉瘤后3.5年、大腿和腹股沟大型多形性脂肪肉瘤后2.5年、大腿下部恶性纤维组织细胞瘤后20个月以及一名儿童股骨下部骨肉瘤后1年，均无残留或转移性肉瘤的迹象。
