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目的探讨三氧化二砷(Arsenic trioxide,As2O3)联合化疗治疗转移性成骨肉瘤、尤文肉瘤的可行性。方法自2002年12月至2005年6月,32例转移性成骨肉瘤、尤文肉瘤患者接受了以三氧化二砷为主的二线化疗方案。其中男性19例,女性13例,年龄7~32岁。成骨肉瘤27例,尤文肉瘤5例;肿瘤转移部位包括肺转移25例,多发骨转移7例。所有病例均为手术后患者,术前及术后共接受过4~6周期的规范化疗。化疗方案:三氧化二砷、VP-16、紫杉醇。化疗2个周期28例,3个周期4例。结果所有患者均获得随访,随访时间6~36个月,平均20个月。经三氧化二砷联合化疗2个疗程后,5例完全缓解(15·6%),转移病灶消失,无新发病灶出现;6例部分缓解(18·8%);13例稳定(40·6%),转移病灶无明显缩小,但出现明显钙化,其中完全钙化2例,部分钙化11例;8例进展(25%),肿瘤体积增大或转移数目增多。21例治疗前碱性磷酸酶或乳酸脱氢酶增高的病例,9例(42·9%)明显下降。32例患者中病情持续稳定,肿瘤得到控制者24例,病情加重5例,死亡3例。结论三氧化二砷是一种低毒、有效的化疗药物,对于Ⅲ期成骨肉瘤、尤文肉瘤患者有较好的近期临床疗效。
Objective To investigate the feasibility of Arsenic trioxide (As2O3) combined with chemotherapy in the treatment of metastatic osteogenic sarcoma and Ewing’s sarcoma. Methods From December 2002 to June 2005, 32 patients with metastatic osteogenic sarcoma and Ewing’s sarcoma received second-line arsenic trioxide-based chemotherapy. Including 19 males and 13 females, aged 7 to 32 years. Osteosarcoma in 27 cases, Ewing sarcoma in 5 cases; tumor metastases, including lung metastasis in 25 cases, multiple bone metastases in 7 cases. All cases were patients after surgery, preoperative and postoperative received a total of 4 to 6 cycles of standard chemotherapy. Chemotherapy program: arsenic trioxide, VP-16, paclitaxel. Chemotherapy 2 cycles in 28 cases, 3 cycles in 4 cases. Results All patients were followed up for 6 to 36 months with an average of 20 months. After two courses of combination of arsenic trioxide and chemotherapy, 5 cases were completely relieved (15.6%), metastatic lesions disappeared and no new lesions appeared; 6 cases were partly relieved (18.8%); 13 cases were stable (40.6%), There was no significant reduction of metastatic lesions, but significant calcification, including 2 cases of complete calcification, partial calcification in 11 cases; 8 cases of progression (25%), the tumor volume increased or the number of metastases increased. Among the 21 cases with elevated alkaline phosphatase or lactate dehydrogenase, 9 cases (42.9%) obviously decreased. Thirty-two patients were stable and their disease was controlled by 24 patients. Five patients were exacerbated and 3 patients died. Conclusion Arsenic trioxide is a kind of low toxicity and effective chemotherapeutic drugs. It has good clinical efficacy in stage Ⅲ osteosarcoma and Ewing’s sarcoma.