Neoadjuvant chemotherapy for osteosarcoma of the extremities with metastases at presentation: recent experience at the Rizzoli Institute in 57 patients treated with cisplatin, doxorubicin, and a high dose of methotrexate and ifosfamide
Neoadjuvant chemotherapy for osteosarcoma of the extremities with metastases at presentation: recent experience at the Rizzoli Institute in 57 patients treated with cisplatin, doxorubicin, and a high dose of methotrexate and ifosfamide
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DOI：
10.1093/annonc/mdg286
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发表时间：
2003-07-01
影响因子：
50.5
通讯作者：
Galletti, S
中科院分区：
文献类型：
--
作者：
Bacci, G;Briccoli, A;Galletti, S
背景资料：有效的辅助或新辅助化疗方案可以显著改善诊断时局限于四肢的高级别骨肉瘤患者的预后。目前，很少有人知道患者转移性疾病presentation.Patients和方法：从1995年5月至2000年5月，57例四肢骨肉瘤，转移性presentation.Treated根据以下方案：原发性化疗，分期，同时切除原发肿瘤和转移灶，维持chemotherapy.Results：35例患者取得缓解。在2至7年的随访中，7例患者持续无疾病，1例死于化疗相关毒性，27例患者复发。22名从未达到缓解的患者中有21名死于肿瘤，27名达到缓解但随后复发的患者中有20名死于肿瘤。在其余7名复发患者中，6名患者仍存活，但疾病未得到控制，而1名患者在最后一次复发后治疗后24个月仍存活且无疾病。2年无事件生存率（EFS）和总生存率（OS）分别为21%和55%。这些结果是显着较差，比在128个当代患者的非转移性疾病的介绍，治疗相同的化疗方案（2年的EFS和OS的75%和94%，respectively）。结论：我们的研究结果证实，骨肉瘤的四肢，转移性的介绍，患者的预后仍然很差，尽管使用积极的治疗。
Background: Effective adjuvant or neoadjuvant regimens of chemotherapy have dramatically improved the prognosis of patients with high-grade osteosarcoma of the extremity, localized at diagnosis. Currently, little is known about patients with metastatic disease at presentation.Patients and methods: From May 1995 to May 2000, 57 patients with osteosarcoma of the extremity, metastatic at presentation, were treated according to the following scheme: primary chemotherapy, restaging, simultaneous resection of primary tumor and metastatic lesions, and maintenance chemotherapy.Results: Thirty-five patients achieved remission. At a follow-up ranging from 2 to 7 years, seven remained continuously free of disease, one died of chemotherapy-related toxicity and 27 patients relapsed. Twenty-one of the 22 patients who never achieved remission died as a result of the tumor, as well as 20 of the 27 who achieved remission but then relapsed. Of the remaining seven relapsing patients, six are alive with uncontrolled disease, while one is alive and free of disease 24 months after the last post-relapse treatment. Two-year event-free survival (EFS) and overall survival (OS) were 21% and 55%, respectively. These results are significantly poorer than those achieved in 128 contemporary patients with non-metastatic disease at presentation, treated with the same chemotherapy protocol (2-year EFS and OS of 75% and 94%, respectively).Conclusions: The results of our study confirm that the prognosis of patients with osteosarcoma of the extremity, metastatic at presentation, remains poor, despite the use of aggressive treatments.