Marginal excision for osteosarcoma with caffeine assisted chemotherapy.
Marginal excision for osteosarcoma with caffeine assisted chemotherapy.
复制标题
咖啡因辅助化疗骨肉瘤的边缘切除。
DOI：
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发表时间：
1999
影响因子：
4.2
通讯作者：
N. Yamamoto
中科院分区：
文献类型：
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作者：
Hiroyuki Tsuchiya;K. Tomita;Y. Mori;N. Asada;N. Yamamoto
作者报告了骨肉瘤的有意边缘切除联合咖啡因辅助化疗，以保持良好的肢体功能。27例骨肉瘤患者(其中22例为IIB期患者，5例为IIIB期患者)术前接受了3~5个疗程的动脉内注射顺铂和咖啡因，不加或加用阿霉素。26例(96%)对化疗有反应的患者，通过有意的边缘手术进行保肢手术，保留了重要的结构，如主要的神经血管束、肌腱、韧带、肌肉和骨骺。肿瘤位于股骨远端11例，胫骨近端8例，腓骨近端4例，肱骨近端2例，股骨近端1例。26例患者对术前化疗的组织学反应显示，19例IIB期骨肉瘤患者无活细胞，2例IIB期和5例IIIB期骨肉瘤患者仅有散在的存活细胞灶。重建方面，8例行牵引成骨，4例行同种异体骨或高压灭菌骨-假体复合移植，2例行高压灭菌骨移植，2例行同种异体骨软骨移植，6例行巨型假体移植，4例行单纯切除。26例患者的平均功能评分为正常的91%。1例局部肿瘤复发，而18例IIB期骨肉瘤患者仍未发病，平均随访61个月。2例IIB期骨肉瘤患者和4例IIIB期骨肉瘤患者死于该病。骨肉瘤的故意边缘切除联合咖啡因辅助化疗是有利的，因为它可以保留健康的重要结构，在选定的病例中可以保留关节。该入路有助于提高骨肉瘤保肢手术的成功率，保护患肢功能。
The authors report on intentional marginal excision for osteosarcoma in conjunction with caffeine assisted chemotherapy for the purpose of preservation of good limb function. Twenty-seven patients with osteosarcoma (22 patients with Stage IIB and five with Stage IIIB) preoperatively were given three-to-five courses of intraarterial cisplatin and caffeine without or with doxorubicin. For 26 (96%) responders to the chemotherapy, limb salvage surgery was conducted by means of an intentional marginal procedure, which led to the preservation of important structures such as major neurovascular bundles, tendons, ligaments, muscles, and the epiphysis. Tumors were located in the distal femur in 11 patients, the proximal tibia in eight, the proximal fibula in four, the proximal humerus in two, and the proximal femur in one patient. The histologic response of these 26 patients to the preoperative chemotherapy showed no viable cells in 19 patients with Stage IIB osteosarcoma and only scattered foci of viable cells in two patients with Stage IIB and five patients with Stage IIIB osteosarcoma. As for reconstruction, distraction osteogenesis was performed in eight patients, allograft or autoclaved bone and prosthesis composite in four, autoclaved bone in two, osteochondral allograft in two, megaprosthesis in six, and resection alone in four patients. The average functional evaluation of the 26 patients was 91% of normal. Local tumor recurrence was seen in one patient, whereas 18 patients with Stage IIB osteosarcoma remain diseasefree with a mean followup of 61 months. Two patients with Stage IIB osteosarcoma and four patients with osteosarcoma Stage IIIB died of the disease. Intentional marginal excision for osteosarcoma in conjunction with caffeine assisted chemotherapy is advantageous because it results in the preservation of healthy important structures, with joint preservation possible in selected cases. This approach should help to improve the success rate of limb salvage surgery for osteosarcoma and to preserve the function of the affected limb.