Rosen G, Forscher C, Lowenbraun S, Eilber F, Eckardt J, Holmes C, Fu Y S
UCLA Sarcoma Study Group.
Cancer. 1994 May 15;73(10):2506-11. doi: 10.1002/1097-0142(19940515)73:10<2506::aid-cncr2820731009>3.0.co;2-s.
This report describes the unusually high response rate of metastatic synovial sarcoma to high dose ifosfamide (14-18 g/m2) when that drug was used to treat 13 consecutive patients with recurrent metastatic synovial sarcoma before surgery (or thoracotomies) to provide optimal salvage therapy for these patients.
Thirteen patients with recurrent or pulmonary metastatic synovial sarcoma seen at the Cedars-Sinai Comprehensive Cancer Center (Los Angeles, CA) from April, 1989 through January, 1993 were treated with high dose ifosfamide (14-18 g/m2). Ifosfamide was infused at the dose of 2 g/m2 over a 4-hour bolus infusion, followed by 2-g/m2 24-hour continuous infusions of ifosfamide, for a total of 14 or 18 g/m2 (6-8 days). Mesna (Mesnex, Bristol-Myers Oncology, Princeton, NJ) was infused with the ifosfamide at equimolar doses. Supplemental sodium bicarbonate (180 mEq) was given daily to prevent severe acidosis. Nine of the thirteen patients were treated with prior chemotherapy for their primary tumors. Prior chemotherapy consisted of doxorubicin (Adriamycin, Adria Labs, Dublin, OH) in all patients and doxorubicin combined with cisplatin in eight of them.
All 13 patients had objective responses to high dose ifosfamide chemotherapy. There were nine partial responses and four complete responses. Five of the patients died of disease at 20-40 months (median, 27 months) from initial therapy. Eight patients have survived from 2 to 43 months (median, 20 months) from initial therapy, and three of these patients are disease free. Those patients surviving disease free had successful surgical removal of their residual metastatic disease after chemotherapy.
Metastatic synovial sarcoma appears to be particularly sensitive to high dose ifosfamide chemotherapy. This experience suggests that there is a role for high dose ifosfamide chemotherapy in preoperative and postoperative adjuvant chemotherapy for primary synovial sarcoma, which is usually always a high grade malignant lesion with a poor prognosis after surgery alone.
本报告描述了转移性滑膜肉瘤对高剂量异环磷酰胺（14 - 18 g/m²）的异常高反应率，当时该药物用于在手术（或开胸手术）前连续治疗13例复发性转移性滑膜肉瘤患者，为这些患者提供最佳挽救治疗。
1989年4月至1993年1月期间在雪松西奈综合癌症中心（加利福尼亚州洛杉矶）就诊的13例复发性或肺转移性滑膜肉瘤患者接受了高剂量异环磷酰胺（14 - 18 g/m²）治疗。异环磷酰胺以2 g/m²的剂量在4小时内静脉推注，随后以2 g/m²的剂量进行24小时持续静脉输注，总量为14或18 g/m²（6 - 8天）。美司钠（Mesnex，百时美施贵宝肿瘤学公司，新泽西州普林斯顿）以等摩尔剂量与异环磷酰胺同时输注。每天给予补充碳酸氢钠（180 mEq）以预防严重酸中毒。13例患者中有9例曾接受过针对其原发性肿瘤的化疗。既往化疗在所有患者中均包含阿霉素（阿霉素，阿德里亚实验室，俄亥俄州都柏林），其中8例患者的化疗方案为阿霉素联合顺铂。
所有13例患者对高剂量异环磷酰胺化疗均有客观反应。其中有9例部分缓解，4例完全缓解。5例患者在初始治疗后20 - 40个月（中位时间，27个月）死于疾病。8例患者从初始治疗后存活了2至43个月（中位时间，20个月），其中3例患者无疾病。那些无疾病存活的患者在化疗后成功手术切除了残留的转移性疾病。
转移性滑膜肉瘤似乎对高剂量异环磷酰胺化疗特别敏感。这一经验表明，高剂量异环磷酰胺化疗在原发性滑膜肉瘤的术前和术后辅助化疗中具有作用，原发性滑膜肉瘤通常是高级别恶性病变，单独手术后预后较差。
