大剂量甲氨蝶呤、表柔比星联合顺铂新辅助化疗骨肉瘤的疗效分析*

目的:观察大剂量甲氨蝶呤(MTX)、表柔比星(EPI)联合顺铂(PDD)新辅助化疗治疗Ⅱb期骨肉瘤的疗效和不良反应。方法:分析25例经病理诊断、初治、Ⅱb期肢体骨肉瘤患者接受大剂量甲氨蝶呤(10～12 g/m²)、表柔比星(80 mg/m²)、顺铂(75 mg/m²)联合化疗的疗效和不良反应。结果:保肢成功率为76 %,5年PFS率达到72 %:5年复发转移率28 %,5年生存率72 %。最常见的不良反应为血液学毒性中性粒细胞减少、贫血、血小板下降、肝功能损害,非血液学毒性脱发、恶心呕吐、腹泻、口腔黏膜炎,多为轻到中度;Ⅲ-Ⅳ级的恶心、呕吐、中性粒细胞减少、脱发、肝功能损害发生率分别为32 %、36 %、68 %和4 %。结论:大剂量甲氨蝶呤、表柔比星、顺铂联合方案新辅助治疗Ⅱb期骨肉瘤保肢成功率高,5年生存率高、复发转移率低,疗效确切,不良反应轻,耐受性良好,值得临床推广使用。

Efficacy analysis of high-dose methotrexate,epirubicin combined with cisplatin in neoadjuvant chemotherapy for osteosarcoma

Objective: To observe the efficacy and adverse reaction of neoadjuvant chemotherapy with high-dose methotrexate (MTX), epirubicin (EPI) and cisplatin (PDD) for stage Ⅱb osteosarcoma. Methods: The efficacy and adverse reactions of high dose methotrexate ( 10-12 g/m²), epirubicin (80 mg/m²) and cisplatin (75 mg/m²) combined chemotherapy in 25 patients with pathological diagnosis, initial treatment and stage Ⅱb limb osteosarcoma were analyzed. Results: The success rate of limb salvage was 76 %, the 5-year PFS rate reached 72 %: the 5-year recurrence and metastasis rate was 28 %, and the 5-year survival rate was 72 %.The most common adverse reactions were hematological toxic neutropenia, anemia, thrombocytopenia, and liver function damage.Non-hematological toxicity was alopecia, nausea and vomiting, diarrhea, and oral mucositis, mostly mild to moderate.The incidences of grade Ⅲ-Ⅳ nausea, vomiting, neutropenia, alopecia and liver dysfunction were 32 %, 36 %, 68 % and 4 %, respectively. Conclusion: High-dose methotrexate, epirubicin and cisplatin combined with neoadjuvant therapy for stage Ⅱb osteosarcoma has high limb salvage success rate, high 5-year survival rate, low recurrence and metastasis rate, exact curative effect, mild adverse reactions and good tolerance, which is worthy of clinical promotion and use.