以介入化疗为基础的股骨远端恶性肿瘤综合治疗

目的探讨皮下埋置式（subcutaneous implantable delivery system,SIDS）动脉化疗应用于股骨远端恶性肿瘤（distal femur neoplasms,DFN）的临床效果。方法自2002年3月至2006年12月共系统治疗DFN39例,其中骨肉瘤33例、恶性纤维组织细胞瘤6例,所有患者均采用以SIDS动脉介入化疗为策略的新辅助化疗,化疗后绝大数患者采取定制人工假体置换。结果随访24~57个月,骨痛缓解率97.4%,骨病变的影像学较显著改变者占74.4%,病理中重度以上化疗反应占87.2%。31例患者无局部复发或远处转移,3例局部复发,2例肺转移患者带瘤生存,3例因肺转移死亡。结论采用股动脉介导的SIDS新辅助化疗对DFN具有良好临床疗效,结合人工假体置换是DFN的有效治疗策略。

The combined treatment based on intra-arterial chemotherapy for distal femur mailgnant neoplasms

Objective To investigate the clinical efficacy of intra-arterial chemotherapy by subcutaneous implantable delivery system （ SIDS ） in the treatment of distal femur malignant neoplasms （DFN）. Methods From March 2002 to December 2006, 39 patients diagnosed as osteosarcoma in 33 patients and malignant fibrous histiocytoma in 6 patients of distal femur were treated with SIDS intra-femoral artery chemotherapy, followed by custom prosthetic reconstruction. Results The average follow-up period was 42 months （ range 24 to 57 months）. Thirty patients had pain relieved completely and 8 patients had pain relieved after chemotherapy. The radiological change was obvious in 29 patients and medium to severe pathological reaction of chemotherapy was found in 34 patients. Local recurrence happened in 3 cases, 2 cases are alive with dis- eases, 3 cases died because of puhnonary metastases and other 31 patients are continuously free of the disease. Conclusion SIDS intra-arterial chemotherapy, which can improve clinical outcome of DFN, combined with custom prosthesis replacement can provide effective method for treatment of DFN.