肢体骨肉瘤经动脉新辅助化疗的疗效分析

目的 探讨肢体骨肉瘤经动脉新辅助化疗的治疗经验.方法 2002年1月至2007年12月,采用化疗泵皮下埋置术前经动脉化疗、局部肿瘤广泛切除加术后辅助化疗治疗111例Ⅱ B期肢体骨肉瘤患者.结果 标准治疗组中77例(89.53%)接受保肢治疗,非标准治疗组中9例(37.5%)接受保肢治疗.Kaplan-Meyer生存曲线分析,111例骨肉瘤患者3年总生存率为68.3%,无瘤生存率为65.9%.非标准动脉化疗组与标准动脉化疗组随访3年的生存率分别为38.9%、80.0%,差异有统计学意义(P=0.000);无瘤牛存率分别为30.1%、79.5%,差异有统计学意义(P=0.000).结论 标准经动脉新辅助化疗较非标准经动脉诱导化疗对ⅡB期肢体骨肉瘤治疗效果显著.

Intraarlerial neoadjuvant chemotherapy for extremity osteosarcoma

Objective To summarize the experiences in intraarterial neoadjuvant chemotherapy for extremity osteosarcoma.Methods Between January 2002 and December 2007,111 patients with stage ⅡB extremity osteosarcoma received preoperative intraarterial chemotherapy after placing chemotherapy pump subeutaneously,en bloc resection and postoperative adjuvant chemotherapy.There were 63 males and 48 females with an average age of 18 years old(range:14-39).The time from symptom onset to hospitalization varied from several days to 6 months.The induction chemotherapy regimen included epirubicin 50-70 mg/m2 by 4-hour intraarterial infusion/day for 3 days]and epirubicin plus adriamycin100-120 mg/m2 by 2-hour intraarterial infusion/day for 3 days]repetitively every 2-3 weeks.Among which 24 cases only received 2 cycles of induction chemotherapy was assigned into the nonstandard chemotherapy group and 87 eases receiving 3-6 cycles of induction chemotherapy the standard chemotherapy group.The number of preoperative chemotherapeutical cycles of standard chemotherapy group depended on the clinical and radiographic evaluation of chemotherapy efficacy.Results The median follow-up time was 28(8-48) months.The rate of extremity preservation surgery was 89.53%(77/86)in the standard chemotherapy group and 37.5%( 9/24)in the nonstandard chemotherapy group.Kaplan-Meier survival analysis showed that the 3-year overall survival rate and disease-free survival rate of au 111 cases were 68.3%and 65.9% respectively.There were significant difierenees in overall survival rate(38.9%,80.0%,P=0.000),disease-free survival rate(30.1%,79.5%,P=0.000),distant metastatic rate(66.67%,16.09%,P=0.0000)and local recurrence rate(58.33%,13.79%,P=0.0000)between two groups.Conchsion Standard intraarterial ueo-adjuvant chemotherapy is more effective than nonstandard intraarterial induction chemotherapy to treat stage Ⅱ B extremity osteosarcoma.