Antman K, Crowley J, Balcerzak S P, Kempf R A, Weiss R B, Clamon G H, Baker L H
Division of Medical Oncology, Columbia-Presbyterian Medical Center, New York, New York, USA.
Cancer. 1998 Apr 1;82(7):1288-95.
Ewing's sarcomas, osteosarcomas, and rhabdomyosarcomas are significantly more responsive to chemotherapy than other sarcomas. Adjuvant chemotherapy is used routinely based on data from randomized trials. Although a percentage of children with locally advanced or metastatic tumors remain curable, few data exist regarding the tumor's natural history or response and survival in adults.
This Phase II study evaluated doxorubicin, dacarbazine, ifosfamide, and mesna (MAID) in adults with inoperable or metastatic Ewing's sarcoma, rhabdomyosarcoma, or osteosarcoma.
Between 1987-1991, 81 patients were entered; 69 patients were eligible. One patient died of neutropenic infection. Ten patients (14%) responded completely and 34 patients (49%) had a complete or partial response. Response rates were significantly higher for patients with Ewing's sarcoma and rhabdomyosarcoma than for those with osteosarcoma (77%, 64%, and 26%, respectively; P < 0.005). Although there were no significant differences in progression free survival by histology, survival for patients with Ewing's sarcoma was significantly longer than for patients with osteosarcoma (P = 0.004.) At the time of last follow-up, 7 patients (10%) were alive without progression: 3 with Ewing's sarcoma, 1 with osteosarcoma, and 3 with rhabdomyosarcoma.
MAID chemotherapy is an active regimen in adults with advanced or metastatic Ewing's sarcoma and rhabdomyosarcoma. Although there was no direct comparison with a doxorubicin and cisplatin-based regimen, the response rate and survival in patients with osteosarcoma suggest that doxorubicin and cisplatin-based chemotherapy would remain the accepted initial chemotherapy regimen. For patients with rhabdomyosarcoma and Ewing's sarcoma, 10-20% of patients remained disease free at 5 years.
尤因肉瘤、骨肉瘤和横纹肌肉瘤对化疗的反应明显优于其他肉瘤。基于随机试验的数据，辅助化疗被常规使用。尽管一部分局部晚期或转移性肿瘤患儿仍可治愈，但关于该肿瘤的自然病史以及成人患者的反应和生存情况的数据却很少。
这项II期研究评估了阿霉素、达卡巴嗪、异环磷酰胺和美司钠（MAID）方案对无法手术或转移性尤因肉瘤、横纹肌肉瘤或骨肉瘤成人患者的疗效。
1987年至1991年间，共纳入81例患者；69例符合条件。1例患者死于中性粒细胞减少感染。10例患者（14%）完全缓解，34例患者（49%）有完全或部分缓解。尤因肉瘤和横纹肌肉瘤患者的缓解率显著高于骨肉瘤患者（分别为77%、64%和26%；P<0.005）。尽管不同组织学类型的无进展生存期无显著差异，但尤因肉瘤患者的生存期显著长于骨肉瘤患者（P = 0.004）。在最后一次随访时，7例患者（10%）存活且无疾病进展：3例尤因肉瘤患者，1例骨肉瘤患者，3例横纹肌肉瘤患者。
MAID化疗方案对晚期或转移性尤因肉瘤和横纹肌肉瘤成人患者是一种有效的治疗方案。尽管未与基于阿霉素和顺铂的方案进行直接比较，但骨肉瘤患者的缓解率和生存率表明，基于阿霉素和顺铂的化疗仍将是公认的初始化疗方案。对于横纹肌肉瘤和尤因肉瘤患者，10%至20%的患者在5年后仍无疾病。
