Harris M B, Gieser P, Goorin A M, Ayala A, Shochat S J, Ferguson W S, Holbrook T, Link M P
Tomorrow's Children's Institute, Hackensack University Medical Center, NJ, USA.
J Clin Oncol. 1998 Nov;16(11):3641-8. doi: 10.1200/JCO.1998.16.11.3641.
To estimate the duration of survival (S) of patients with metastatic osteosarcoma (MOS) at diagnosis treated with a multiagent, ifosfamide-containing chemotherapeutic and surgical regimen and to evaluate the toxicity of this regimen.
Thirty patients aged younger than 30 years received two courses of ifosfamide followed by surgery on the primary tumor and metastatic sites. Patients then received a postsurgical multiagent chemotherapeutic regimen that consisted of high-dose methotrexate (HDMTX), ifosfamide, doxorubicin, and cisplatin.
The 5-year event-free survival (EFS) rate was 46.7% (95% confidence interval [CI]; 28.5 to 64.9) and 5-year S rate was 53.3% (95% CI; 35.1 to 71.5). Three patients with bone metastases and one patient with lymph node metastases died. Twenty-six patients presented with pulmonary metastatic nodules only. Eight of these patients had at least eight nodules at diagnosis and had an estimated 5-year EFS rate of 25.0% compared with 66.7% for the 18 patients with less than eight nodules (P=.06). Fourteen patients presented with bilateral lung metastases and had a 5-year EFS rate of 35.7% compared with the 12 patients who presented with unilateral involvement and had a 5-year EFS rate of 75.0% (P=.03). The hematopoietic toxicity experienced by the patients during the entire regimen was relatively mild. Seven patients had renal toxicity characterized by hypophosphatemia and/or hypokalemia.
This ifosfamide-containing regimen is tolerable and effective in the treatment of patients with osteosarcoma (OS) who present with lung metastases. However, better regimens are required for this group of patients.
评估接受含异环磷酰胺的多药化疗及手术方案治疗的转移性骨肉瘤（MOS）患者确诊时的生存时长（S），并评估该方案的毒性。
30名年龄小于30岁的患者接受了两个疗程的异环磷酰胺治疗，随后对原发性肿瘤和转移部位进行手术。患者随后接受了术后多药化疗方案，该方案包括大剂量甲氨蝶呤（HDMTX）、异环磷酰胺、阿霉素和顺铂。
5年无事件生存率（EFS）为46.7%（95%置信区间[CI]；28.5至64.9），5年生存率为53.3%（95%CI；35.1至71.5）。3名骨转移患者和1名淋巴结转移患者死亡。26名患者仅出现肺转移结节。其中8名患者在确诊时有至少8个结节，估计5年EFS率为25.0%，而18名结节少于8个的患者为66.7%（P = 0.06）。14名患者出现双侧肺转移，5年EFS率为35.7%，而12名单侧受累患者的5年EFS率为75.0%（P = 0.03）。患者在整个治疗方案中经历的造血毒性相对较轻。7名患者出现以低磷血症和/或低钾血症为特征的肾毒性。
这种含异环磷酰胺的方案在治疗出现肺转移的骨肉瘤（OS）患者中是可耐受且有效的。然而，这组患者需要更好的治疗方案。
