大剂量甲氨蝶呤联合顺铂治疗骨肉瘤的临床研究  

Clinical study of high dose MTX combined with cisplatin in the treatment of osteosarcoma

作　　者：林峰[1] 陶钧[1] 蔡讯[1] 唐晓春[1] 孙元珏[1] 郭跃武[1] 赵晖[1] 姚阳[1] 

机构地区：[1]上海交通大学附属第六人民医院肿瘤内科,上海200233

出　　处：《临床肿瘤学杂志》2006年第1期11-14,共4页Chinese Clinical Oncology

基　　金：上海市卫生局青年科研基金资助项目(034Y15)

摘　　要：目的:观察以大剂量甲氨蝶呤(MTX)联合顺铂(PDD)治疗骨肉瘤的疗效及毒副反应。方法:40例骨肉瘤患者均有组织病理学或细胞学诊断及可评价客观指标。采用大剂量MTX6～8g/m2d1,静脉滴注6h,使用后4h配合甲酰四氢叶酸钙(CF)解救14～17次;PDD60～80mg/m2d8,21天为1周期,2周期评价疗效。化疗期给予水化、碱化及利尿处理并配合MTX的血药浓度监测。结果:CR10.0%,PR62.5%,SD12.5%,PD15.0%,有效率(CR+PR)为72.5%。并且初治组疗效高于复治组(P<0.05),Ⅱ期疗效高于Ⅲ期(P<0.05)。不良反应主要为肝功能损害(52.5%)、皮疹(12.5%)、口腔粘膜炎(25.0%)和白细胞减少(20.0%)。结论:HDMTX联合PDD治疗骨肉瘤疗效肯定,耐受性好,值得临床推广使用。Objective：To evaluate the efficacy and toxicity of high dose MTX（ HD - MTX - CFR） combined with cisplatin （PDD） in the treatment of osteosarcoma. Methods：40 cases with osteosarcoma pathologically and cytologically proved were treated with HD - MTX 6 - 8g/m^2 6h on the first day ,combined with CF rescue ,and PDD 60 - 80mg/m^2 was given on day 8. Hydration ,alkalization ,diuresis and surveillance of serum MTX level were administered routinely during chemotherapy. Each case was assessed after two cycles. Results：It showed that CR 10.0% ,PR 62.5% ,SD 12.5%, PD 15.0% ,and the overall response rate was 72.5%. The response rate of chemonaive group was higher than that of the retreatment group, and it was higher in stage Ⅱ group than that in stage Ⅲ group. The main side effects included damages of liver function ： grade Ⅰ - Ⅱ 52.5 %, grade Ⅲ - Ⅳ 2.5 %, mucositis ： grade Ⅰ - Ⅱ 20.0% ,grade Ⅲ- Ⅳ 5.0% ,neutropenia：grade Ⅰ - Ⅱ 17.5% ,grade Ⅲ - Ⅳ 5.0%. Conclusion： HD -MTX plus cisplatin is effective for osteosarcoma and toxicities are well tolerated. It is recommended to use clinically.

关 键 词：骨肉瘤 大剂量甲氨蝶呤化疗 疗效 副作用 

分 类 号：R730.53[医药卫生—肿瘤] R738.1[医药卫生—临床医学]