中国骨与关节杂志
中國骨與關節雜誌
중국골여관절잡지
Chinese Journal of Bone and Joint
2015年
1期
4-9
,共6页
王冰%于秀淳%许宋锋%徐明%郑凯%刘江
王冰%于秀淳%許宋鋒%徐明%鄭凱%劉江
왕빙%우수순%허송봉%서명%정개%류강
放化疗,辅助%软组织肿瘤%肉瘤%四肢
放化療,輔助%軟組織腫瘤%肉瘤%四肢
방화료,보조%연조직종류%육류%사지
Chemoradiotherapy,adjuvant%Soft tissue neoplasms%Sarcoma%Extremities
目的：分析探讨新辅助化疗治疗肢体软组织肉瘤(softtissuesarcoma，STS)的临床疗效及价值。方法选取2009年5月至2012年6月，我科经新辅助化疗[术前顺铂＋异环磷酰胺＋阿霉素(cisplatin＋ifosfamide＋adriamycin，DDP＋IFO＋ADM，DIA )化疗2个周期＋手术治疗＋术后 DIA 化疗6个周期]治疗的28例肢体STS患者，其中男18例，女10例；年龄15～62岁，中位年龄35岁。DIA 1个周期的化疗方案为：第1天DDP 120 mg/m2，第7～9天每天按序均给予ADM 30 mg/m2、IFO 2.0 g/m2，第10～11天IFO 2.0 g / m2。对所有患者进行随访，复查肺部 CT 及病变部位 X 线片，记录复发、转移、死亡情况。参照实体瘤疗效评价标准( response evaluation criteria in solid tumour，RECIST )1.1评价化疗疗效；按照化疗常见不良反应事件评价标准( common terminology criteria for adverse events，CTCAE )4.0对化疗期间的不良反应进行评价。结果本组28例手术均进行顺利，总失血量50～600ml，平均260ml，切口如期愈合。DIA化疗方案进行了术前2个周期、术后6个周期化疗，持续时间为38周，28例共进行了224个化疗周期。28例随访12～59个月，随访结束时，存活23例，其中无瘤生存20例，带瘤生存3例。本组2年无瘤生存率71.4%，2年总生存率82.1%。术后转移5例，均肺部转移而死亡；4例术后复发，复发率12.3%。4例复发患者与3例肺转移患者，于发现后先辅助三维适行放疗。经过术前化疗，肿瘤体积平均缩小(30.2±11.3)%，尤其肿瘤直径＞15 cm的22例，肿瘤体积平均缩小(42.7±7.8)%；28例中完全缓解( complete remssion，CR )0例，部分缓解( partial remission，PR )12例，稳定( stable disease，SD )14例，疾病进展( progression diseas，PD )2例，客观缓解率( objective response rate，ORR )为42.9%，疾病控制率( disease control rate，DCR )为92.9%；患者对化疗耐受性良好，主要化疗不良反应均为一过性，经用药对症处理后症状消失。结论新辅助化疗方案治疗肢体STS，术前化疗可明显缩小STS的体积，减轻肿瘤周围的软组织水肿，可控制微小转移灶，很好地配合STS的手术切除；能够提高患者的总生存率及无瘤生存率，有利于肢体STS 的保肢治疗；其近、中期疗效满意，不良反应可耐受，是治疗STS重要有效的方法。
目的：分析探討新輔助化療治療肢體軟組織肉瘤(softtissuesarcoma，STS)的臨床療效及價值。方法選取2009年5月至2012年6月，我科經新輔助化療[術前順鉑＋異環燐酰胺＋阿黴素(cisplatin＋ifosfamide＋adriamycin，DDP＋IFO＋ADM，DIA )化療2箇週期＋手術治療＋術後 DIA 化療6箇週期]治療的28例肢體STS患者，其中男18例，女10例；年齡15～62歲，中位年齡35歲。DIA 1箇週期的化療方案為：第1天DDP 120 mg/m2，第7～9天每天按序均給予ADM 30 mg/m2、IFO 2.0 g/m2，第10～11天IFO 2.0 g / m2。對所有患者進行隨訪，複查肺部 CT 及病變部位 X 線片，記錄複髮、轉移、死亡情況。參照實體瘤療效評價標準( response evaluation criteria in solid tumour，RECIST )1.1評價化療療效；按照化療常見不良反應事件評價標準( common terminology criteria for adverse events，CTCAE )4.0對化療期間的不良反應進行評價。結果本組28例手術均進行順利，總失血量50～600ml，平均260ml，切口如期愈閤。DIA化療方案進行瞭術前2箇週期、術後6箇週期化療，持續時間為38週，28例共進行瞭224箇化療週期。28例隨訪12～59箇月，隨訪結束時，存活23例，其中無瘤生存20例，帶瘤生存3例。本組2年無瘤生存率71.4%，2年總生存率82.1%。術後轉移5例，均肺部轉移而死亡；4例術後複髮，複髮率12.3%。4例複髮患者與3例肺轉移患者，于髮現後先輔助三維適行放療。經過術前化療，腫瘤體積平均縮小(30.2±11.3)%，尤其腫瘤直徑＞15 cm的22例，腫瘤體積平均縮小(42.7±7.8)%；28例中完全緩解( complete remssion，CR )0例，部分緩解( partial remission，PR )12例，穩定( stable disease，SD )14例，疾病進展( progression diseas，PD )2例，客觀緩解率( objective response rate，ORR )為42.9%，疾病控製率( disease control rate，DCR )為92.9%；患者對化療耐受性良好，主要化療不良反應均為一過性，經用藥對癥處理後癥狀消失。結論新輔助化療方案治療肢體STS，術前化療可明顯縮小STS的體積，減輕腫瘤週圍的軟組織水腫，可控製微小轉移竈，很好地配閤STS的手術切除；能夠提高患者的總生存率及無瘤生存率，有利于肢體STS 的保肢治療；其近、中期療效滿意，不良反應可耐受，是治療STS重要有效的方法。
목적：분석탐토신보조화료치료지체연조직육류(softtissuesarcoma，STS)적림상료효급개치。방법선취2009년5월지2012년6월，아과경신보조화료[술전순박＋이배린선알＋아매소(cisplatin＋ifosfamide＋adriamycin，DDP＋IFO＋ADM，DIA )화료2개주기＋수술치료＋술후 DIA 화료6개주기]치료적28례지체STS환자，기중남18례，녀10례；년령15～62세，중위년령35세。DIA 1개주기적화료방안위：제1천DDP 120 mg/m2，제7～9천매천안서균급여ADM 30 mg/m2、IFO 2.0 g/m2，제10～11천IFO 2.0 g / m2。대소유환자진행수방，복사폐부 CT 급병변부위 X 선편，기록복발、전이、사망정황。삼조실체류료효평개표준( response evaluation criteria in solid tumour，RECIST )1.1평개화료료효；안조화료상견불량반응사건평개표준( common terminology criteria for adverse events，CTCAE )4.0대화료기간적불량반응진행평개。결과본조28례수술균진행순리，총실혈량50～600ml，평균260ml，절구여기유합。DIA화료방안진행료술전2개주기、술후6개주기화료，지속시간위38주，28례공진행료224개화료주기。28례수방12～59개월，수방결속시，존활23례，기중무류생존20례，대류생존3례。본조2년무류생존솔71.4%，2년총생존솔82.1%。술후전이5례，균폐부전이이사망；4례술후복발，복발솔12.3%。4례복발환자여3례폐전이환자，우발현후선보조삼유괄행방료。경과술전화료，종류체적평균축소(30.2±11.3)%，우기종류직경＞15 cm적22례，종류체적평균축소(42.7±7.8)%；28례중완전완해( complete remssion，CR )0례，부분완해( partial remission，PR )12례，은정( stable disease，SD )14례，질병진전( progression diseas，PD )2례，객관완해솔( objective response rate，ORR )위42.9%，질병공제솔( disease control rate，DCR )위92.9%；환자대화료내수성량호，주요화료불량반응균위일과성，경용약대증처리후증상소실。결론신보조화료방안치료지체STS，술전화료가명현축소STS적체적，감경종류주위적연조직수종，가공제미소전이조，흔호지배합STS적수술절제；능구제고환자적총생존솔급무류생존솔，유리우지체STS 적보지치료；기근、중기료효만의，불량반응가내수，시치료STS중요유효적방법。
Objective To investigate and analyze the clinical effects and value of neoadjuvant chemotherapy in the treatment of extremity soft tissue sarcomas ( STS ).Methods A total of 28 patients with extremity STS were treated by neoadjuvant chemotherapy from May 2009 to June 2012, namely preoperative chemotherapy for 2 cycles, surgical treatment and postoperative chemotherapy for 6 cycles. There were 18 males and 10 females, whose median age was 35 years old ( range: 15-62 years ). Combination therapy with cisplatin ( DDP ), ifosfamide ( IFO ) and adriamycin ( ADM ) was performed before and after the surgery, which was also called DIA chemotherapy. The patients were treated with DDP 120 mg/m2 on the 1st day, ADM 30 mg/m2 and IFO 2.0 g/m2 on the 7th-9th day in sequence and IFO 2.0 g/m2 on the 10th-11th day for a cycle. All the patients were followed up, and CT scans of the lungs and X-ray iflms of the lesion sites were reviewed. The cases of recurrences, metastases and death were recorded. The chemotherapeutic effects were evaluated according to Response Evaluation Criteria in Solid Tumors ( RECIST 1.1 ) guidelines. Common Terminology Criteria for Adverse Events, Version 4.0 ( CTCAE 4.0 ) was used to observe the adverse reaction of chemotherapy.Results All the surgeries were successful, and complete wound healing was achieved as scheduled in all the cases. The mean total blood loss was 260 ml ( range: 50-600 ml ). It took 38 weeks in DIA chemotherapy, including 2 cycles of preoperative chemotherapy and 6 cycles of postoperative chemotherapy. A total of 224 cycles of chemotherapy were carried out in the 28 patients. They were followed up for 12-59 months.At the end of the follow-up, 23 patients survived. Disease-free survival was realized in 20 patients and survival with tumors in 3 patients, and the survival time was 24-59 months. The 2-year disease-free survival rate was 71.4% and the overall 2-year survival rate was 82.1%. Postoperative metastases were noticed in 5 patients, who all died of lung metastases. Postoperative recurrences were found in 4 patients, and the recurrence rate was 12.3%. Three dimensional conformal radiation therapy was performed on 4 patients with recurrences and 3 patients with lung metastases. The size of tumors was reduced by ( 30.2±11.3 ) % on average after the preoperative chemotherapy, which was reduced by ( 42.7±7.8 ) % in 22 patients whose tumors were more than 15cm in the diameter. Complete remssion ( CR ) was noticed in 0 case, partial remission ( PR ) in 12 cases, stable disease ( SD ) in 14 cases and progression disease ( PD ) in 2 cases. The objective response rate ( ORR ) was 42.9%, and the disease control rate ( DCR ) was 92.9%. The chemotherapy was well tolerated in all the patients, whose main adverse reaction was transient. And the symptoms disappeared after drug treatment.Conclusions The neoadjuvant chemotherapy is important and effective in the treatment of extremity STS. The size of STS can be signiifcantly reduced and the surrounding soft tissue edema can be relieved after the preoperative chemotherapy. The micrometastases can be inhibited, which helps the surgical resection. Both the overall survival rate and disease-free survival rate are improved, which beneifts the limb salvage therapy. The short- and medium-term effects are satisfactory and the adverse reactions are tolerable.
