MMIA术前化疗在骨肉瘤保肢术中的意义

Significance of preoperative chemotherapy with MMIA for osteosarcoma

摘要: 目的　探讨以大剂量甲氨喋呤、异环磷酰胺和阿霉素组成的MMIA方案在骨肉瘤保肢术中的价值。方法　 9例骨肉瘤于术前化疗 2疗程后行保肢术, 对比观察术前未行化疗的 2 1例骨肉瘤患者。评价化疗对保肢术的可行性及术后并发症的影响。结果　无 1例因并发症而终止化疗, 化疗后AKP、LDH明显下降, 7例患者的疼痛消失, 影像学显示肿瘤明显缩小、钙化。术后标本肿瘤细胞坏死率Ⅳ级 3例, Ⅲ级 3例, Ⅱ级 2例, Ⅰ级 1例。术前化疗组中 1例切口延迟愈合, 随访期间 1例复发, 1例死亡。非化疗组 3例术后切口延迟愈合, 随访期间 6例复发, 7例肺转移, 7例死亡。统计学分析发现术前化疗与术后复发有关, 与切口愈合无关。结论　MMIA术前化疗可以在不影响切口愈合的前提下, 扩大保肢手术适应症, 改善手术局部控制率

Abstract: Objective To explore the significance of preoperative chemotherapy with MMIA regimen composed of HDMTX, IFO and ADR for the salvage limb operation of osteosarcoma. Methods 9 cases of osteosarcoma were treated with MMIA preoperatively, 21 cases were treated with salvage limb operation without preoperative chemotherapy. Many parameters of blood were examined during chemotherapy. Tumor cell necrosis rate (TCNR) of postoperative samples was calculated in all preoperative chemotherapy cases. Recording the c...