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目的探讨多中心成骨肉瘤的治疗方法。方法1998年1月至2005年6月治疗多中心成骨肉瘤患者9例,男7例,女2例。9例患者的临床特征、影像学表现、病理学检查均证实多中心成骨肉瘤的诊断。其中6例患者初诊时即存在多发骨肉瘤病灶;3例初诊时为单一骨肉瘤病灶,而后分别在确诊6、8、11个月出现第二处骨肉瘤病灶。1例患者因经济原因放弃治疗,其余8例患者接受阿霉素60mg/m2、顺铂100mg/m2、氨甲蝶呤8～12g/m2、长春新碱1.4mg/m2、异环磷酰胺12.5g/m2化疗1周期。化疗后根据病灶数目、部位以及对化疗的反应等决定包括手术、化疗在内的进一步治疗方案。对病灶数目较少、病灶可广泛切除的患者,如果化疗反应好,则在化疗的基础上广泛切除肿瘤,手术原则同单发性骨肉瘤;如果全身病灶数目多、部分病灶位于中轴骨等不易广泛切除的部位,则根据病情采取适当的姑息手术。对上述化疗反应差的患者,应用三氧化二砷、紫杉醇、VP-16化疗。结果放弃治疗的1例患者于确诊5个月后死于肿瘤引起的全身衰竭,5例初诊存在多发骨肉瘤病灶的患者平均生存时间9.8个月,其中2例对化疗反应好且完成4周期以上化疗的患者平均生存时间为15个月,对化疗反应差以及未能完成化疗的3例患者平均生存时间仅为7.1个月。3例病灶不同时出现的多中心成骨肉瘤患者平均随访2年,2例带瘤生存,无肺转移;1例无瘤生存。结论多中心成骨肉瘤预后较差,经积极的化疗,能够延长患者生命,改善预后。
Objective To investigate the treatment of multi-center osteosarcoma. Methods From January 1998 to June 2005, 9 patients with multi-center osteosarcoma were treated, including 7 males and 2 females. Nine patients with clinical features, imaging findings, pathological examination confirmed the diagnosis of multicentric osteosarcoma. Among them, 6 patients had multiple osteosarcoma lesions at the time of first visit; 3 patients had single osteosarcoma lesions at the time of first visit, and the second osteosarcoma lesions appeared at 6, 8 and 11 months of diagnosis respectively. One patient discontinued treatment for economic reasons, and the remaining eight received doxorubicin 60 mg / m2, cisplatin 100 mg / m2, methotrexate 8-12 g / m2, vincristine 1.4 mg / m2, ifosfamide 12.5 g / m2 chemotherapy cycle. After chemotherapy according to the number of lesions, the site and the response to chemotherapy, including surgery, chemotherapy, including further treatment options. On the lesser the number of lesions can be widely resected patients, if the chemotherapy response is good, then the extensive excision of the tumor on the basis of chemotherapy, surgical principles with single osteosarcoma; if the number of systemic lesions and some lesions in the axial bones Not easy to remove the site, then according to the condition to take appropriate palliative surgery. In patients with poor response to chemotherapy, the application of arsenic trioxide, paclitaxel, VP-16 chemotherapy. Results 1 patient who gave up treatment died of tumor-induced systemic failure 5 months after diagnosis, and 5 patients with newly diagnosed multiple osteosarcoma had a mean survival time of 9.8 months, of which 2 patients responded well to chemotherapy and completed more than 4 cycles The mean survival time of patients who underwent chemotherapy was 15 months. The 3 patients who had poor response to chemotherapy and failed to complete chemotherapy had an average survival of only 7.1 months. Three cases of multi-center osteosarcoma who did not appear at the same time were followed up for an average of 2 years. Two patients survived without tumor and one patient had no tumor. Conclusions Multi-center osteosarcoma has a poor prognosis. After active chemotherapy, it can prolong the life of patients and improve the prognosis.