Treatment of metastatic osteosarcoma at diagnosis: A pediatric oncology group study
Treatment of metastatic osteosarcoma at diagnosis: A pediatric oncology group study
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DOI：
10.1200/jco.1998.16.11.3641
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发表时间：
1998-11-01
影响因子：
45.3
通讯作者：
Link, MP
中科院分区：
文献类型：
--
作者：
Harris, MB;Gieser, P;Link, MP
目的：评价含异环磷酰胺的多药化疗和手术方案治疗转移性骨肉瘤患者初诊时的生存时间(S)，并评价该方案的毒性。结果：5年无事件生存率为46.7%(95%可信区间，28.5~64.9)，S 5年生存率为53.3%(95%可信区间，35.1~71.5)。三名骨转移患者和一名淋巴结转移患者死亡。26例仅表现为肺转移结节。其中8名患者在确诊时至少有8个结节，估计5年EFS率为25.0%，而少于8个结节的18名患者的5年EFS率为66.7%(P=0.06)。14例患者双侧肺转移，5年EFS率为35.7%；12例单侧肺转移患者，5年EFS率为75.0%(P=0.03)。患者在整个方案中所经历的造血毒性相对较轻。7例患者出现肾毒性，表现为低磷血症和/或低钾血症。结论：异环磷酰胺方案对伴有肺转移的骨肉瘤患者是可耐受且有效的。然而，这类患者需要更好的治疗方案。(C)1998年由美国临床肿瘤学会主办。
Purpose: To estimate the duration of survival (S) of patients with metastatic osteosarcoma (MOS) at diagnosis treated with a multiagent, ifosfamide-containing chemotherapeutic and surgical regimen and to evaluate the toxicity of this regimen.Patients and Methods: Thirty patients aged younger than 30 years received two courses of ifosfamide followed by surgery on the primary tumor and metastatic sites. Patients then received a postsurgical multiagent chemotherapeutic regimen that consisted of high-dose methotrexate (HDMTX), ifosfamide, doxorubicin, and cisplatin.Results: The 5-year event-free survival (EFS) rate was 46.7% (95% confidence interval [CI]; 28.5 to 64.9) and 5-year S rate was 53.3% (95% CI; 35.1 to 71.5). Three patients with bone metastases and one patient with lymph node metastases died. twenty-six patients presented with pulmonary metastatic nodules only. Eight of these patients had at least eight nodules at diagnosis and had an estimated 5-year EFS rate of 25.0% compared with 66.7% for the 18 patients with less than eight nodules (P = .06). Fourteen patients presented with bilateral lung metastases and had a 5-year EFS rate of 35.7% compared with the 12 patients who presented with unilateral involvement and had a 5-year EFS rate of 75.0% (P = .03). The hematopoietic toxicity experienced by the patients during the entire regimen was relatively mild. Seven patients had renal toxicity characterized by hypophosphatemia and/or hypokalemia.Conclusion: This ifosfamide-containing regimen is tolerable and effective in the treatment of patients with osteosarcoma (OS) who present with lung metastases. However, better regimens are required for this group of patients. (C) 1998 by American Society of Clinical Oncology.