Intensification of preoperative chemotherapy for osteogenic sarcoma: Results of the memorial Sloan-Kettering (T12) protocol
Intensification of preoperative chemotherapy for osteogenic sarcoma: Results of the memorial Sloan-Kettering (T12) protocol
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DOI：
10.1200/jco.1998.16.7.2452
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发表时间：
1998-07-01
影响因子：
45.3
通讯作者：
Healey, JH
中科院分区：
文献类型：
--
作者：
Meyers, PA;Gorlick, R;Healey, JH
目的：以前在骨肉瘤（OS）中观察到，术前化疗一段时间后切除原发肿瘤的坏死程度可预测随后的无事件生存期（EFS）。本研究的目的是确定更密集的术前化疗是否会增加具有良好组织学反应的患者比例并改善EFS。患者和方法：1986年至1993年间，73例OS患者在Memorial-Sloan Kettering癌症中心（MSKCC）接受T12方案治疗。患者被随机分为基于T10方案的治疗和术前强化化疗的治疗。更强化的术前方案包括两个疗程的顺铂（CDDP）和阿霉素（DOX），除了常规的术前方案高剂量甲氨蝶呤（HD MTX）和博来霉素、环磷酰胺和放线菌素（BCD）。结果：加强术前化疗的方案使具有良好组织学反应的患者比例适度增加（III级或IV级组织学反应为44%，对照组为37%，IV级组织学反应为33%，对照组为13%）。EFS继续与组织学反应相关。精算5年病灶患者的EFS在术前强化化疗方案中为78%，在对照组中为73%。结论：尽管术前强化化疗后组织学反应良好的患者比例略有增加，但未观察到EFS的改善。(C)美国临床肿瘤学会1998。
Purpose: It has been observed previously in osteosarcoma (OS) that the degree of necrosis of the resected primary tumor following a period of preoperative chemotherapy is predictive of subsequent event-free survival (EFS). The aim of this study was to determine if more intensive preoperative chemotherapy would increase the proportion of patients with a good histalogic response and improve EFS.Patients and Methods: Seventy-three patients with OS were treated at Memorial-Sloan Kettering Cancer Center (MSKCC) on the T12 protocol between 1986 and 1993. Patients were randomized between therapy based on the T10 protocol and therapy with more intensive preoperative chemotherapy. The more intensive preoperative regimen consisted of two courses of cisplatin (CDDP) and doxorubicin (DOX) in addition to the usual preoperative regimen of high-dose methotrexate (HD MTX) and bleomycin, cyclophosphamide, and dactinomycin (BCD).Results: The regimen with more intensive preoperative chemotherapy achieved a modest increase in the proportion of patients with a good histologic response (44% with a grade III or IV histologic response v 37% in the control arm, 33% with grade IV histologic response v 13% in the control arm). EFS continued to correlate with histologic response. The actuarial 5-year EFS in patients with localised disease was 78% for the regimen with more intensive preoperative chemotherapy and 73% for the control arm.Conclusion: Despite modest increases in the proportion of patients with good histalogic response with intensified preoperative chemotherapy, no improvement in EFS was observed. (C) 1998 by American Society of Clinical Oncology.