Long-term outcome for patients with nonmetastatic osteosarcoma of the extremity treated at the Istituto Ortopedico Rizzoli according to the Istituto Ortopedico Rizzoli Osteosarcoma-2 protocol: An updated report
Long-term outcome for patients with nonmetastatic osteosarcoma of the extremity treated at the Istituto Ortopedico Rizzoli according to the Istituto Ortopedico Rizzoli Osteosarcoma-2 protocol: An updated report
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DOI：
10.1200/jco.2000.18.24.4016
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发表时间：
2000-12-15
影响因子：
45.3
通讯作者：
Campanacci, M
中科院分区：
文献类型：
--
作者：
Bacci, G;Ferrari, S;Campanacci, M
目的：评估四肢骨肉瘤患者在同一机构接受新辅助化疗并观察至少10年的长期预后。患者和方法：四肢非转移性骨肉瘤患者术前应用大剂量甲氨蝶呤、顺铂和阿霉素(ADM)治疗。结果：在1986年9月至1989年12月的164例患者中，手术保肢136例(82%)，组织学疗效良好的117例(71%)。在10年至13年(中位数为11.5年)的随访中，101名患者(61%)持续无病，61名复发，2名死于ADM引起的心脏毒性。反应好和反应差的患者预后无差异。ADM引起的心脏毒性(6例)、男性不育(12例可评估患者中的10例)和继发性恶性肿瘤(7例)是化疗的主要并发症。尽管进行了大量保肢手术，但仅有4例(2.4%)局部复发。结论：对于四肢非转移性骨肉瘤患者，采用积极的新辅助化疗可治愈60%以上，其中80%以上的患者可避免截肢，因为局部或全身复发、心肌病和继发性恶性肿瘤在治疗开始5年或更长时间后仍有可能，建议对这些患者进行长期随访。J Clin Oncol18：4016-4027。(C)2000年，由美国临床肿瘤学会提供。
Purpose: To provide an estimate of long-term prognosis for patients with osteosarcoma of the extremity treated in a single institution with neoadjuvant chemotherapy and observed for at least 10 years.Patients and Methods: Patients with nonmetastatic osteosarcoma of the extremity were preoperatively treated with high-dose methotrexate, cisplatin, and doxorubicin (ADM). Postoperatively, good responders (90% Or more tumor necrosis) received the same three drugs-used before surgery, whereas poor responders (less than 90% tumor necrosis) received ifosfamide and etoposide in addition to those three drugs.Results: For the 164 patients who entered the study between September 1986 and December 1989, surgery was a limb salvage in 136 cases (82%) and a good histologic response was observed in 117 patients (71%). At a follow-up ranging from 10 to 13 years (median, 11.5 years), 101 patients (61%) remained continuously free of disease, 61 relapsed, and two died of ADM-induced cardiotoxicity. There were no differences in prognosis between good and poor responding patients. ADM-induced cardiotoxicity (six patients), male infertility (10 of the 12 assessable patients), and second malignancies (seven patients) were the major complications of chemotherapy. Despite the large number of limb salvages performed, only four local recurrences (2.4%) were registered.Conclusion: With an aggressive neoadjuvant chemotherapy, it is possible to cure more than 60% of patients with nonmetastatic osteosarcoma of the extremity and amputation may be avoided in more than 80% of them, Because local or systemic relapses, myocardiopathies, and second malignancies are possible even 5 years or more after the beginning of treatment, a long-term follow-up is recommended for these patients. J Clin Oncol 18:4016-4027. (C) 2000 by American Society of Clinical Oncology.