改良MAID方案治疗54例晚期软组织肉瘤的疗效分析  

Effect of Modified MAID Regimen for Patients with Advanced Soft Tissue Sarcoma

作　　者：李恩孝[1] 张雅婷[1] 尚金堂[2] 许真 耿熠[4] 李署明[1] 施璠[1] 吴胤瑛[1] 

机构地区：[1]西安交通大学医学院第一附属医院肿瘤内科,陕西西安710061 [2]商洛市中心医院肿瘤科,陕西商洛726000 [3]安康中心医院肿瘤科,陕西安康725000 [4]宝鸡市中心医院肿瘤内科,陕西宝鸡721008

出　　处：《癌症》2006年第8期1048-1051,共4页Chinese Journal of Cancer

摘　　要：背景与目的:临床研究表明MAID方案连续静脉输注72h治疗晚期软组织肉瘤的近期疗效较以阿霉素(ADR)为主的二药联合方案疗效高,肿瘤无进展时间长,但是对患者长期生存无明显改善,严重的Ⅲ/Ⅳ度血液学毒性和治疗相关死亡影响了其在临床广泛使用。本研究通过用四氢吡喃阿霉素(THP-ADR)替代MAID方案中的ADR和改良异环磷酰胺(IFO)用法治疗晚期软组织肉瘤,观察改良方案的疗效和不良反应。方法:通过多中心协作筛选符合标准的患者接受IFO2000mg/m2静脉滴注4hd1～3,美斯钠1200mg/m2在IFO治疗的0、4和8h静脉滴注d1～3,THP-ADR20mg/m2和达卡巴嗪(DTIC)333.3mg/m2持续静脉滴注d1～3,THP-ADR和DTIC溶于同一液体瓶或泵中通过中心静脉导管输注,每3周重复,至少2周期,评定近期疗效和毒性反应。对所有完成2周期治疗的患者每2月随访1次,直至随访截止。利用寿命表法计算长期生存率和肿瘤进展时间。结果:可评价的54例患者全部完成至少2周期改良MAID方案化疗,总有效率42.59%。不良反应较轻,Ⅲ+Ⅳ度中性粒细胞减少发生率25.93%,粒细胞减少性发热11.11%,Ⅲ+Ⅳ度血小板减少发生率16.67%,其它毒性少见,无明显的肝肾毒性、无治疗相关性死亡和中枢神经系统毒性反应。随访2年,至肿瘤进展时间为7个月,1年和2年生存率分别为61.11%和36.36%。结论:改良MAID方案简化了原方案中三种药物均需要同时连续输注的过程,有比较好的有效率和长期生存,未见严重毒性反应,耐受性良好,值得进一步前瞻性随机对照研究。BACKGROUND ＆ OBJECTIVES： Clinical study suggests that 72-hour continuous infusion （CIV） of MAID regimen is more effective and achieves longer time of no progression than ADR-based two-drug regimen in advanced soft tissue sarcoma （ASTS） treatment, but has no improvement on the long-term survival. Because of the severe grade 3/4 toxicities as well as treatment-related deaths, the regimen has not been widely applied in ASTS. This study was to investigate the efficacy and toxicity of the modified MAID regimen in ASTS treatment. METHODS： In the modified regimen, adriamycin （ADR） was substituted with tetrahydropyranyl adriamycin （THP-ADR） and the application of ifosfamide （IFO） was modified. All enrolled patients received chemotherapy （IFO 2 000 mg·m^-2, 4h , day 1-3; mesna 1 200 mg·m^-2 at 0, 4 and 8 hours of IFO infusion, day 1-3; THP-ADR 20 mg·m^-2 and dacarbazine （DTIC） 333.3 mg·m^-2 were mixed in the same bag or pump, CIV for 3 days）. The therapy was repeated every 3 weeks for at least 2 cycles before evaluating the effects and toxicities. The patients received follow-up every 2 months after completing 2 cycles until the study was finished. Life table was used to calculate long-term survival rates and time to progression. RESULTS： Fifty-four cases of evaluable patients had completed at least 2 cycles of modified MAID chemotherapy. The overall response rate was 42.59%. The toxicities were mild. Grade 3/4 neutropenia and thrombocytopenia were 25.93% and 16.17%, respectively. Neutropenia fever was 11.11%. There were no other toxicities, such as hepatic and renal toxicities; no central nervous system toxicity and treatment-related deaths. During 2 year follow-up, time to progression was 7 months, 1- and 2- year survival rates were 61.11% and 36.36%, respectively. CONCLUSIONS： Modified MAID regimen simplifies the application of treatment procedure compared with original regimen, which three drugs have to be CIV simultaneously. Moreover the modified MAID regimen has better survi

关 键 词：软组织肉瘤/化学疗法 阿霉素 异环磷酰胺 联合用药 疗效 不良反应 

分 类 号：R738.6[医药卫生—肿瘤]