Ornadel D, Souhami R L, Whelan J, Nooy M, Ruiz de Elvira C, Pringle J, Lewis I, Steward W P, George R, Bridgewater J
Department of Oncology, Middlesex Hospital, London, United Kingdom.
J Clin Oncol. 1994 Sep;12(9):1842-8. doi: 10.1200/JCO.1994.12.9.1842.
This report describes the toxicity and feasibility of administering doxorubicin (DOX) and cisplatin (CDDP) at 2-week intervals with granulocyte colony-stimulating factor (G-CSF) to patients with osteosarcoma and the compatibility of this regimen with endoprosthetic surgery performed after three cycles.
Twenty-four patients with biopsy-proven osteosarcoma were treated with three preoperative cycles of DOX 25 mg/m2/d on days 1 to 3 and CDDP 100 mg/m2 on day 1 with G-CSF 5 micrograms/kg/d on days 4 to 14. Surgery was scheduled at week 6 to be followed by three further cycles of chemotherapy at 2-week intervals.
Two-week chemotherapy was feasible, but delays and dose reductions only allowed 74% and 78% of the intended dose-intensity of DOX and CDDP to be administered. Thrombocytopenia accounted for 50% of delays. Significant toxicity included neutropenic sepsis, severe mucositis, prolonged nausea and vomiting, and electrolyte disturbances. Twenty-one limb-salvage procedures and one amputation were performed. There were eight episodes of excessive perioperative bleeding.
Intensive 2-week chemotherapy with intercurrent surgery is feasible and allows a greater dose-intensity of chemotherapy to be administered compared with the same regimen administered at 3-week intervals without G-CSF. The toxicity is considerable, but manageable.
本报告描述了每2周一次给予多柔比星（DOX）和顺铂（CDDP）联合粒细胞集落刺激因子（G-CSF）治疗骨肉瘤患者的毒性和可行性，以及该方案与三个周期后进行的假体植入手术的兼容性。
24例经活检证实为骨肉瘤的患者接受了三个术前周期的治疗，具体方案为：第1至3天给予DOX 25mg/m²/d，第1天给予CDDP 100mg/m²，第4至14天给予G-CSF 5μg/kg/d。手术安排在第6周进行，随后每2周进行三个周期的化疗。
每2周进行一次化疗是可行的，但延迟和剂量减少仅允许给予预期剂量强度74%的DOX和78%的CDDP。血小板减少占延迟原因的50%。显著的毒性包括中性粒细胞减少性败血症、严重的粘膜炎、长期的恶心和呕吐以及电解质紊乱。进行了21例保肢手术和1例截肢手术。有8次围手术期出血过多的情况。
强化的每2周化疗并同期进行手术是可行的，与每3周一次且不使用G-CSF的相同方案相比，能够给予更高剂量强度的化疗。毒性相当大，但可控制。
