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目的分析探讨新辅助化疗治疗肢体软组织肉瘤(soft tissue sarcoma,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IFO2.0 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50~600 ml,平均260 ml,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。
Objective To investigate the clinical efficacy and value of neoadjuvant chemotherapy in the treatment of soft tissue sarcoma (STS). Methods From May 2009 to June 2012, 2 patients underwent neoadjuvant chemotherapy [cisplatin + ifosfamide + adriamycin (DDP) plus chemotherapy plus cisplatin plus ifosfamide + adriamycin Cycle + surgery + postoperative DIA chemotherapy 6 cycles] treatment of 28 cases of limb STS patients, including 18 males and 10 females; aged 15 to 62 years, with a median age of 35 years. DIA 1 cycle chemotherapy regimen: DDP 120 mg / m 2 on day 1, ADM 30 mg / m 2, IFO 2.0 g / m 2 on day 7 to day 9, and IFO 2 g / m 2 on days 10 to 11, m2. Follow-up was performed on all patients. Pulmonary CT and lesion site radiographs were reviewed and the recurrence, metastasis and death were recorded. The response to chemotherapy was evaluated according to response evaluation criteria in solid tumor (RECIST) 1.1. Adverse reactions during chemotherapy were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE) 4.0. Results The operation of 28 cases in this group all went well. The total blood loss was 50 ~ 600 ml with an average of 260 ml. The incision healed on schedule. The DIA chemotherapy regimen performed two cycles of preoperative chemotherapy and six cycles of chemotherapy with a duration of 38 weeks and a total of 224 cycles of chemotherapy in 28 patients. Twenty-eight patients were followed up for 12 to 59 months. At the end of follow-up, 23 patients survived, including 20 patients with no tumor and 3 patients with tumor. The 2-year disease-free survival rate of 71.4%, 2-year overall survival rate of 82.1%. Postoperative metastasis in 5 cases, all died of pulmonary metastases; 4 cases of recurrence, the recurrence rate was 12.3%. 4 patients with recurrent patients and 3 patients with lung metastases, after the discovery of three-dimensional adaptive radiotherapy. After preoperative chemotherapy, the volume of tumor was reduced by an average of 30.2 ± 11.3%, especially in 22 cases with tumor diameter> 15 cm. The average volume of tumor was reduced by 42.7 ± 7.8%. The complete remission (CR) , 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%. The disease control rate (DCR) was 92.9%. The patients were well tolerated by chemotherapy and the main adverse reactions of chemotherapy were transient. Symptoms disappeared after symptomatic treatment. Conclusion Neoadjuvant chemotherapy regimen for the treatment of limbs STS, preoperative chemotherapy can significantly reduce the volume of STS, reduce the soft tissue around the tumor edema, can control the tiny metastases, and good with STS surgical resection; can improve the overall survival rate of patients and no Tumor survival rate is conducive limb salvage limb STS treatment; its near and mid-term efficacy is satisfactory, adverse reactions can be tolerated, is an important and effective method of treatment of STS.