Pattern of relapse in patients with osteosarcoma of the extremities treated with neoadjuvant chemotherapy
Pattern of relapse in patients with osteosarcoma of the extremities treated with neoadjuvant chemotherapy
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DOI：
10.1016/s0959-8049(00)00361-0
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发表时间：
2001-01-01
影响因子：
8.4
通讯作者：
Smith, KVJ
中科院分区：
文献类型：
--
作者：
Bacci, G;Ferrari, S;Smith, KVJ
1983年至1995年，在Rizzoli研究所，570例四肢骨肉瘤患者接受了五种不同的新辅助化疗方案治疗。手术包括83%的保肢，5%的旋转成形术和12%的截肢术。5年无事件生存率（EFS）为60%，根据所遵循的方案而变化，范围为47.6%至66.4%。234例患者复发。分析复发模式。平均复发时间为23.8个月（范围：2-96）。全身性复发的第一个部位是88%的肺（其中32%的肺转移少于3个，68%的肺转移3个或更多），9%的骨，2%的肺和骨，3%的其他部位。复发时间和肺转移灶数目与化疗方案的疗效密切相关。与5年EFS分别为47.6%和52.5%的两种方案相比，采用3种方案治疗的患者5年EFS超过60%，复发时间较晚，肺部病变较少。局部复发率相对较低（6%）。这与方案或手术类型无关：保肢（6.4%）、旋转成形术或截肢（4.1%）。然而，局部复发率是非常高的（21.9%），在少数患者（7%），有不到广泛的手术切缘。我们的结论是，对于新辅助化疗治疗的四肢骨肉瘤患者：（a）根据化疗方案的疗效，全身复发的模式发生变化。在评价新研究的初步结果以及确定随访时间时，应始终考虑到这一点;（B）只要实现广泛的手术切缘，保肢手术是安全的，不会危及患者的结局。(C)2001爱思唯尔科技有限公司版权所有。
570 patients with osteosarcoma of the extremities were treated with five different protocols of neoadjuvant chemotherapy at Rizzoli Institute between 1983 and 1995. Surgery consisted of limb salvage in 83% rotation plasty in 5% and amputation in 12%. The 5-year event-free survival (EFS) was 60% which varied according to the protocol followed, ranging from 47.6% to 66.4%. 234 patients relapsed. The pattern of relapse was analysed. The mean relapse time was 23.8 months (range: 2-96). The first site of systemic relapse was the lung in 88% (32% of these had less than three pulmonary metastases and 68% three or more), bone in 9%, lung and bone in 2% and other sites in 3%. The relapse time and the number of pulmonary metastases were strictly correlated with the efficacy of the protocol of chemotherapy used. Patients treated with the three protocols that gave a 5-year EFS of more than 60% relapsed later and had fewer pulmonary lesions than patients treated with the two protocols that gave a 5-year EFS of 47.6% and 52.5%. The rate of local recurrence was relatively low (6%). This was not correlated with the protocol or the type of surgery used: limb salvage (6.4%), rotation plasty or amputation (4.1%). However, the rate of local recurrence was very high (21.9%) in the few patients (7%) that had less than wide surgical margins. We conclude that for patients with osteosarcoma of the extremities treated with neoadjuvant chemotherapy: (a) the pattern of systemic relapse changes according to the efficacy of the protocol of chemotherapy used. This should be always considered when evaluating the preliminary results of new studies as well as in defining the time of follow-up; (b) limb salvage procedures are safe and do not jeopardise the outcome of the patient, provided that wide surgical margins are achieved. (C) 2001 Elsevier Science Ltd. All rights reserved.