摘要
目的 评估骨肉瘤辅助化疗方案的中远期疗效。方法 1989 年1 月～1995 年12 月采用我们制定的以国产铂类药物和阿霉素为主的方案治疗ⅡB 期肢体骨肉瘤共67 例, 其中男47 例, 女20例;年龄10 ～51 岁,平均20 岁。股骨下端45 例,胫骨上端14 例,腓骨上端和肱骨上端各3 例,股骨上端2例。成骨细胞型51 例,成软骨细胞型6 例,成纤维细胞型5 例和其他类型5 例。根据化疗的具体方法可将本组资料分成三组: 术前顺铂高温隔离肢体灌注化疗结合术后化疗23 例; 术前卡铂高温隔离肢体灌注化疗结合术后化疗20 例和仅接受术后化疗24 例。手术方法: 截肢或关节离断35 例, 保肢29 例和Tikhoff- Linberg 手术3 例。所有接受高温隔离灌注化疗病例的手术标本均以多切片进行肿瘤细胞坏死率评估。以SPSS7-0 统计软件包进行统计学处理。结果 经过3 ～9 年的随访,术后1 年内复发或转移6 例,术后1 ～2 年内复发或转移20 例,术后2 ～3 年内复发或转移4 例,术后3 年5 个月1 例保肢病例局部复发;术后4 年5 个月和5 年6 个月发生肺部转移各1 例。截肢组35 例和Tikhoff - Linberg 手术3 例无一例局部复发,保肢29 例中局部复发3 例。67 例二年无瘤生存41 例(61-19 % ) ,三年无瘤生存37 例(55-22 % ) , 五年无瘤生存可能率为(49-56 % ) 。统?
Objective To evaluate the clinical results of treatment for osteosarcoma of the extremities with adjuvant chemotherapy regimen Methods Sixty seven patients with ⅡB extremity osteosarcoma were treated with the combination of adjuvant chemotherapy regimen and definitive surgery Forty seven of them were male and twenty four were female The mean age of the patients at the time of diagnosis was 20 years (ranged 10～51 years) Sixty four lesions involved the lower extremity, with 45 involving the distal femur, 14 the upper tibia, 3 the upper fibula and 2 the proximal femur; Three involved the upper end of the humerus The study of subtype of osteosarcoma revealed that 51 were osteoblastic, 6 chondroblastic, 5 fibroblastic and 5 the other subtypes The patients were divided into three groups according to the adjuvant chemotherapy regimen given, the first group consisted of 23 cases, who were treated with the combination of the presurgical cisplatin hyperthermic isolated limb perfusion (CDP-HILP) and postoperative chemotherapy; the second group of 20 cases, who were treated with the combination of the presurgical CBP-HILP and postoperative chemotherapy; and the other 24 cases were treated with postoperative chemotherapy alone Twenty nine of the 67 patients treated surgically had limb salvage procedures; 35 had amputations and 3 had Tikhoff-Limbergs surgery Multiple histologic sections were procured and examined from each of the surgical specimens in the patients who were treated with preoperative HILP to determine the effect of chemotherapy All patients were followed from 3 to 9 years, and the data were statistically analeyed using SPSS 7 0 Results Among 67 cases, 41 (61 19%) had relapse free survival(RFS) in 2 years after surgery, 37 (55 22%) had RFS in 3 years after surgery, and RFS probability at 5 years after surgery was 49 56% Log-rank analysis showed no significant difference in RFS probability among the three groups(P=0 517 1), but there was a significant difference in RFS probability between patients who had limb salvage procedure and those had amputation(P=0 009 7) Age, sex, site and subtype were not significant prognostic variables in this group of patients Correction analysis revealed that the RFS probability were not related with the rate of the tumor necrosis (P=0 058) Conclusion The data revealed that 1) The chemotherapy regimen mainly including platinic drugs was effective treatment for osteosarcoma ,and was more simple and less expensive than any previous reported chemotherapy for steosarcoma, 2) CDP of chemotherapy regimen for osteosarcoma, which had more nephritic and audio toxicity could be replaced by CBP , And 3)Whether the preoperative chemotherapy is suitable for the patients in whom amputation is inevitable (based on age ,size, and involvement of local structure) remains unclear
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2000年第1期35-39,共5页
Chinese Journal of Orthopaedics
关键词
骨肉瘤
药物疗法
辅助疗法
远期疗效
Osteosarcoma
Chemotherapy, adjuvant
Doxorubicin
Cisplatin
Carboplatin
Disease free survival
