骨肉瘤优化新辅助化疗方案临床疗效观察  

Clinical therapeutic efficacy analysis of the optimized neo-adjuvant chemotherapy protocols in the treatment of osteosarcoma

作　　者：刘琦[1] 李晓阳[1] 肖涛[1] 

机构地区：[1]中南大学湘雅二医院骨科,长沙410011

出　　处：《中国医师杂志》2014年第5期634-637,共4页Journal of Chinese Physician

摘　　要：目的 观察大剂量甲氨蝶呤（MTX）、顺铂（DDP）、吡柔比星（THP）和异环磷酰胺（IFO）4种药物优化组合方案治疗肢体骨肉瘤的疗效及毒副反应.方法 回顾性分析中南大学湘雅二医院2007年7月至2011年12月应用优化新辅助化疗方案（MTX 200 mg/kg静滴6h,d1;用药12h后CF解救12次,每次9mg;DDP 100 mg/m2、THP 30 mg静滴d8-10;IFO 3.0g/m2静滴d16-18,美司那与IFO等量,每天IFO用后第0、3、6、9小时静滴）治疗的125例骨肉瘤患者的临床资料,观察此化疗方案的疗效及毒副反应.结果 优化新辅助化疗方案治疗Ⅱa期和Ⅱb期骨肉瘤的有效缓解率分别为36.4％ （8/22）和79.6％ （82/103）,差异有统计学意义（P＜0.05）.125例患者中52例（41.6％）患者疾病复发或转移,47例（37.6％）患者死亡,二年无瘤生存率55.2％,总生存率62.4％,生存时间（17.7±8.3）个月.患者化疗期间主要毒副反应为骨髓抑制和消化道反应如恶心呕吐等,其中Ⅲ-Ⅳ级粒细胞减少的发生率为71.2％,Ⅲ-Ⅳ级恶心和Ⅲ-Ⅳ级呕吐的发生率分别为37.6％和13.6％.结论 将大剂量MTX、DDP、THP和IFO这4种药物进行优化组合治疗骨肉瘤患者具有疗效确切、可耐受的特点.Objective To investigate the efficacy and side effects of new combination of high-dose methotrexate （MTX）,cisplatin （DDP）,pirarubicin （THP）,and ifosfamide （IFO） in the treatment of extremity osteosarcoma patients.Methods A retrospective analysis was conducted for 125 osteosarcoma patients treated with the optimized neo-adjuvant chemotherapy combined with the four drugs mentioned above （MTX 200 mg/kg iv 6 h d1,CF 9 mg at one time,12 times; DDP 100 mg/m2,THP 30 mg iv,d8-10;IFO 3.0 g/m2 iv d16-18,mesna after IFO for 0,3,6,9 h）.The efficacy and side effects of the therapeutic scheme were evaluated.Results The effective salvage rates of Ⅱ a and Ⅱb schemes were 36.4% （8/22） and 79.6% （82/103） with a statistical significance （P 〈 0.05）.The 2-year survival rate of schemes was 62.4%,and the survival time was（17.7 ± 8.3）months.The main side effects were myelo-suppression,nausea,and vomiting,etc.The incidence rate of myelo-suppression,nausea,and vomiting with grade Ⅲ-Ⅳ accounted for 71.2%,37.6%,and 13.6%,respectively.Conclusions The optimized neo-adjuvant therapy strategy based on high-dose MTX,DDP,THP,and IFO is effective in the treatment of osteosarcoma.

关 键 词：骨肉瘤 药物疗法 甲氨蝶呤 治疗应用 顺铂 治疗应用 多柔比星 类似物和衍生物 多柔比星 治疗应用 异环磷酰胺 治疗应用 甲氨蝶呤 副作用 顺铂 副作用 多柔比星 副作用 异环磷酰胺 副作用 治疗结果 

分 类 号：R737.9[医药卫生—肿瘤]