RESUMO
Preoperative intraarterial (IA) cisplatin (CDP) was administered to 92 patients with nonmetastatic osteosarcoma. The ages of the patients ranged from 4 to 28 years. Sixty-four patients (70%) received 2 or 3 preoperative courses and 28 (30%) received 4 or more. Sixty-two specimens were available for pathologic examination to assess the degree of tumor necrosis. More than 90% tumor destruction was observed in 16 of 42 patients (38%) who received 1 to 3 preoperative courses as opposed to 17 of 20 (85%) who received 4 or more courses. Patients who received 4 or more courses had a 2-fold probability of achieving more than 90% tumor necrosis, and 68% underwent conservative surgery. Of those who received 3 or less courses, 23% underwent conservative surgery. Postoperatively, patients were treated with intravenous (IV) CDP alternating with doxorubicin (ADR) (Adriamycin, Adria Laboratories, Columbus, OH). Pulmonary metastases developed in 36 patients, bone metastases in 2, and local recurrence in 6. Two patients died of cardiac failure without evidence of disease. Thus, 46 patients (50%) were continuously free of disease 18 to 78 months after diagnosis. Univariate and multivariate analyses showed that male sex, low grade preoperative chemotherapy-induced necrosis, and nonosteoblastic histologic condition were prognostic factors predictive of recurrence, while male sex and large tumor size were prognostic factors predictive of death. These results are comparable with those reported by other centers and are superior to our previous experiences that yielded survival rates of 5% to 10%. A substantial number of patients also had the opportunity to achieve tumor removal with conservative surgery.
Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/terapia , Osteossarcoma/mortalidade , Osteossarcoma/terapia , Adolescente , Adulto , Amputação Cirúrgica , Neoplasias Ósseas/patologia , Neoplasias Ósseas/secundário , Criança , Pré-Escolar , Cisplatino/uso terapêutico , Terapia Combinada , Doxorrubicina/uso terapêutico , Extremidades/cirurgia , Feminino , Humanos , Masculino , Necrose , Osteossarcoma/patologia , Osteossarcoma/secundário , Prognóstico , Análise de SobrevidaRESUMO
La combinación de mitoxantrona (M), 5-fluorouracilo (F) y ciclofosfamida (C), se administró como tratamiento inicial a 180 pacintes con cáncer avanzado de la glándula mamaria. Este estudio no comparativo se llevó a cabo en 7 diferentes instituciones médicas de Argentina, Brasil y México. Las dosis utilizadas fueron: mitoxantrona 12 mg/m2 i.v. día 1-21; 5-fluorouracilo 500 mg'm2 i.v. días 1-8-21 y ciclofosfamida 500 mg/m2 i.v. día 1-21. Las dosis se modificaron de acuerdo a la toxicidad presentada. En el 37% de los 1026 ciclos se presentó leucopenia <2000/mm3 y trombocitopenia <100,000/mm3 en el 16%. Náusea y vómito se presentaron en 82%, diarrea en el 27% y alopecia en el 74%. Respuesta global se observó en 88 de 147 pacientes valorables (60%); respuesta completa en 32 (21.8%) y respuesta parcial en 56 (38%), nos e observaron cambios en 38 (25.9%) y progresión en 21 (14.3%). La sobrevida promedio en este grupo fue de 25 meses; actualmente continúan con vida y sin evidencia de actividad tumoral, a más de 6 años, 24 (16.3%) de las pacientes. Aparte de la mielosupesión, en su mayoría neutropenia, la combinación MFC generalmente fue efectiva y bien tolerada con una baja incidencia de efectos secundarios. Se concluye que mitoxantrona en combinación con 5-fluorouracilo y ciclofosfamida, contribuyen a prolongar la sobrevida de las enfermas con cáncer mamario avanzado, mejorando la calidad de vida en un número importante de ellas. Se recomienda la combinación de MFC como esquema de priemra línea.