甲氨蝶呤、顺铂、阿霉素和异环磷酰胺治疗ⅡB期肢体骨肉瘤的临床观察

临床肿瘤学杂志

甲氨蝶呤、顺铂、阿霉素和异环磷酰胺治疗ⅡB期肢体骨肉瘤的临床观察

胡蓓蓓^1,2，汤丽娜¹，郑水儿¹，孙元珏¹，沈赞¹，林峰¹，姚阳¹

1 上海交通大学附属第六人民医院肿瘤内科 2 苏州大学医学部研究生院

收稿日期:2012-12-27 修回日期:2013-02-26 出版日期:2013-04-30 发布日期:2013-04-30
通讯作者: 林峰

Clinical observation of methotrexate， cisplatin， adriamycin and ifosfamide for stage ⅡB extremity osteosarcoma

HU Beibei， TANG Lina， ZHENG Shuier， SUN Yuanjue， SHEN Zan， LIN Feng， YAO Yang

Department of Medical Oncology，the Sixth People's Hospital， Shanghai Jiaotong University

Received:2012-12-27 Revised:2013-02-26 Online:2013-04-30 Published:2013-04-30
Contact: LIN Feng

摘要/Abstract

摘要： 目的观察大剂量甲氨蝶呤（MTX）、顺铂（DDP）、阿霉素（ADM）和异环磷酰胺（IFO）4种药物两种不同组合方案治疗ⅡB期肢体骨肉瘤的疗效及毒副反应。
方法回顾性分析接受4种药物化疗方案的185例ⅡB期肢体骨肉瘤患者，其中93例接受意大利IOR-OS／N-5方案（MTX 8～12g／m²静滴6h，d₁；用药后12h亚叶酸钙解救12次，每次15mg；DDP 80～100mg／m²、ADM 60mg／m²静滴，d8；IFO 2.0g／m²静滴，d₂₁～d₂₅；美司那400mg每天IFO用后第0、4、8h静滴），92例接受优化方案（除ADM由第8天静滴改为第21天与IFO联用外，其他同IOR-OS／N-5方案）。比较两种方案的疗效及毒副反应。结果 IOR-OS／N-5方案和优化方案组的保肢率分别为52.7％（49／93）和58.7％（54／92）。两组患者的3年复发率分别为14.0％、7.6％，3年转移率分别为47.3％、30.4％，差异均有统计学意义（P＜0.05）；两组患者的3年生存率分别为57.0％、75.0％，差异有统计学意义（P＜0.05）。两组患者的中位无病生存时间（DFS）分别为22.2个月（95％CI：16.2～28.2个月）和29.0个月（95％CI：23.8～34.3个月），差异有统计学意义（P=0.024）；两组患者的中位总生存时间（OS）分别为32.2个月（95％CI：23.2～38.2个月）和36.1个月（95％CI：33.8～44.3个月），差异有统计学意义（P=0.032）。两组患者的主要毒副反应为肝功能损害、骨髓抑制、恶心呕吐等。其中3、4级肝功能损害的发生率分别为35.2％、16.6％，3、4级白细胞减少的发生率分别为22.6％、30.2％。结论将大剂量MTX、DDP、ADM和IFO这4种药物进行优化组合治疗骨肉瘤患者的耐受性好，疗效提高。

Abstract: Objective To investigate the efficacy and side effects of two combinations of highdose methotrexate（MTX）， cisplatin（DDP）， adriamycin（ADM） and ifosfamide（IFO） in the treatment of extremity osteosarcoma patients with stage ⅡB. Methods A retrospective analysis was conducted for 185 osteosarcoma patients treated with the four drugs mentioned above. Ninety three patients received the Italian therapeutic scheme IOR-OS／N-5（MTX 812g／m²iv 6h，d₁，CF 15mg at one time，12 times；DDP 80-100mg／m²，ADM 60mg／m² iv，d8；IFO 20g／m2iv d21d25，mesna 400mg after IFO for 0，4，8h）and the remaining 92 patients received the therapeutic scheme optimized（MTX 812g／m2iv 6h，d1，CF 15mg at one time，12times；DDP 80-100mg／m² iv，d₈；ADM 60mg／m² iv d₂₁，IFO 2.0g／m²iv d₂₁-d₂₅，mesna 400mg after IFO for 0，4，8h）. To compare the efficacy and side effects of two therapeutic schemes. Results The limb salvage rates of IOROS／N-5 and optimized schemes were 52.7％（49／93）and 58.7％（54／92）， respectively. The 3-year recurrence rates of IOR-OS／N-5 and optimized schemes were 14.0％ and 7.6％，respectively. The 3-year metastasis rates of IOR-OS／N-5 and optimized schemes were 47.3％ and 30.4％， respectively. The 3-year survival rates of IOR-OS／N-5 and optimized schemes were 57.0％ and 75.0％ with statistical significance（P＜0.05）. The median diseasefree survival times of two groups were 22.2 months（95％CI：16.2-28.2）and 29.0 months（95％CI：23.8-34.3），respectively. There was statistical significance（P=0.024）.The median overall survival times of two groups were 32.2 months（95％CI：23.2-38.2） and 36.1 months（95％CI：33.8-44.3），respectively. There was statistical significance（P=0.032）. The main side effects were liver function damages， myelosuppression， nausea and vomiting and so on. The incidence rate of liver damage with grade 3-4 accounted for 35.2％ and 16.6％ in IOR-OS／N-5 and optimized scheme groups， respectively. Grade 3-4 neutropenia accounted for 22.6％ and 30.2％ in two groups， respectively. Conclusion Optimization of highdose MTX， DDP， ADM and IFO based on the Chinese patients body condition increases the resistance and efficacy in the treatment of osteosarcoma.

胡蓓蓓^1,2，汤丽娜¹，郑水儿¹，孙元珏¹，沈赞¹，林峰¹，姚阳¹. 甲氨蝶呤、顺铂、阿霉素和异环磷酰胺治疗ⅡB期肢体骨肉瘤的临床观察[J]. 临床肿瘤学杂志, 2013, 18(4): 353-.

HU Beibei， TANG Lina， ZHENG Shuier， SUN Yuanjue， SHEN Zan， LIN Feng， YAO Yang. Clinical observation of methotrexate， cisplatin， adriamycin and ifosfamide for stage ⅡB extremity osteosarcoma[J]. Chinese Clinical Oncology, 2013, 18(4): 353-.

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