Adjuvant multiple drug chemotherapy for osteosarcoma of the extremity
Adjuvant multiple drug chemotherapy for osteosarcoma of the extremity
复制标题
四肢骨肉瘤的辅助多药化疗
作者：
C. Pratt;E. Shanks;O. Hustu;G. Rivera;John Smith;A. P. Kumar
四肢骨肉瘤的治疗结果一直很差，转移通常会在确诊后两年内导致死亡。由于发生转移的风险很大，20名患者在骨肉瘤截肢后接受了阿霉素、环磷酰胺和大剂量甲氨蝶呤-亚叶酸钙的辅助化疗，最长达12个月。其中16名患者存活，11名截肢后6至34个月内无明显肿瘤。5名患者在接受化疗时被发现有肺转移，3名患者在化疗完成后出现转移。一名患者在接受大剂量甲氨蝶呤-亚叶酸钙救援后第三次治疗后死亡。其他毒性包括恶心、呕吐、粘膜溃疡、感染、血液学异常、肾功能和肝功能改变，以及轻微的凝血功能异常。骨肉瘤的自然病史可能已经被这些药物的使用改变了，时间超过了预测肺转移的中值时间。通过这种辅助化疗，一些患者的微小转移被根除。对于发生转移的患者，这些转移的发现时间和发现时的数量都会延迟。
Results of treatment for osteosarcoma of the extremity have been poor with metastases usually causing death within 2 years following diagnosis. Because of the great risk of development of metastases, 20 patients have received adjuvant chemotherapy with Adriamycin, cyclophosphamide and high‐dose meth‐otrexate‐leucovorin rescue for up to 12 months following amputation for osteosarcoma. Sixteen of these patients are surviving; 11 are free of evident tumor from 6 to 34 months following amputation. Five patients were found to have pulmonary metastases while receiving chemotherapy and three patients developed metastases following completion of chemotherapy. One patient died following her third treatment with high‐dose methotrexate‐leucorovin rescue. Other toxicity included nausea, vomiting, mucosal ulcerations, infections, hematologic abnormalities, changes in kidney and liver functions tests, and minor coagulation abnormalities. The natural history of osteosarcoma may have been modified by the use of these agents for periods exceeding the median time to predicted detection of pulmonary metastases. Microscopic metastases of some patients were eradicated by this adjuvant chemotherapy. For patients who developed metastases, these metastases were delayed in their time of detection and in their number at the time of detection.