Muñoz Villa A, Ocete G, Aymerich M L, Maldonado S, Otheo E, Calvo M, Amaya J
Servicio de Pediatría, Hospital Ramón y Cajal, Madrid.
Med Clin (Barc). 1996 Jun 29;107(5):161-4.
A preoperative and postoperative chemotherapy regimen was applied to nonmetastatic osteosarcoma of the extremities in patients under 16 years of age to prevent the progress to metastatic disease and reduce the volume of the primary tumor in order to assess a conservative surgery.
A modified T-10 chemotherapy regimen was used before surgery, including high dose methotrexate, vincristine, bleomycin, cyclophosphamide and dactinomycin. After surgery patients with a grade of tumor necrosis > 90% received the same regimen up to 45 weeks of treatment. For the cases with necrosis < 90%, this regimen was substituted by adriamycin and cisplatinum. Survival was studied in relation with age, sex, tumor site, levels of alkaline phosphatase and LDH, surgical treatment and tumor necrosis in the surgical specimen after preoperative chemotherapy. Uni and multivariate analysis were performed.
Twenty seven patients with ages ranging from 5 to 15 years (median 11 years) were treated. The most common site of primary tumor was femur, followed by humerus and tibia. In 9 cases (33%) tumor necrosis was > 90%. Consecutive surgery was performed in 20 patients and 7 suffered amputation or disarticulation of the extremity. Twenty patients remain alive and disease-free at a median follow-up of 84 months. The probability of disease-free survival at 50 months is 71%. The only factor which influenced significantly the survival was the grade of tumor necrosis. Survival was 100% for the 9 patients with necrosis > 90% and 53% for the 18 cases with necrosis > 90% (p = 0.022).
Preoperative and postoperative chemotherapy achieve disease-free survival in more than two thirds of patients with nonmetastatic osteosarcoma of the extremities and allow a non mutilating surgical treatment in the majority of them.
对16岁以下肢体非转移性骨肉瘤患者采用术前及术后化疗方案，以防止疾病进展至转移阶段，并缩小原发肿瘤体积，从而评估保肢手术的可行性。
术前采用改良的T-10化疗方案，包括大剂量甲氨蝶呤、长春新碱、博来霉素、环磷酰胺和放线菌素D。术后肿瘤坏死率>90%的患者接受相同方案治疗，疗程长达45周。对于坏死率<90%的病例，该方案换用阿霉素和顺铂。研究生存情况与年龄、性别、肿瘤部位、碱性磷酸酶和乳酸脱氢酶水平、手术治疗以及术前化疗后手术标本中的肿瘤坏死情况的关系。进行单因素和多因素分析。
治疗了27例年龄在5至15岁（中位年龄11岁）的患者。原发肿瘤最常见的部位是股骨，其次是肱骨和胫骨。9例（33%）肿瘤坏死率>90%。20例患者接受了保肢手术，7例接受了截肢或关节离断术。20例患者在中位随访84个月时仍存活且无疾病复发。50个月时无病生存率为71%。唯一显著影响生存的因素是肿瘤坏死程度。坏死率>90%的9例患者生存率为100%，坏死率<90%的18例患者生存率为53%（p = 0.022）。
术前及术后化疗使超过三分之二的肢体非转移性骨肉瘤患者实现无病生存，并使大多数患者能够接受非致残性手术治疗。
