Stage ⅡB 골육종환자의 항암 화학요법(Modified T10 Protocol) 후의 5년 생존율
The Survival Rate of Stage ⅡB Osteosarcoma after Neoadjuvant Chemotherapy (Modified T10 Protocol)
대한암학회지 1998년 30권 3호 p.591 ~ 598
김재도, 배정수, 조명래,
소속 상세정보
김재도 ( )
고신대학교 복음병원 정형외과학교실
배정수 ( )
고신대학교 복음병원 정형외과학교실
조명래 ( )
고신대학교 복음병원 정형외과학교실
KMID : 0360319980300030591
Abstract
결론
Modified T10 protocol에 따라 시행한 38예의 Stage ⅡB 골육종 환자에서 전체적인 5년
생존율 73.6%, 5년 지속적 무병생존율 64%를 보여주었다.
골육종 환자의 생존율 향상을 위해서는 항암화학요법시 부작용을 최소화하고, 충분한 항
암약물 투여에 대한 방사선학적 및 병리학적 반응에 대한 술전, 술후 항암 화학요법의
tailoring이 중요할 것으로 생각되었다.
Purpose : The survival rate according to the methods of treatment was significantly
higher in the osteosarcoma patients in which limb salvage operation with neoadjuvant
chemotheraphy. The purpose of this study is to analyze the results of treatment in the
Stage ⅡB osteosarcoma patients who treated with modified 710 protocol.
Materials and Methods : From Jun. 1990 to Oct. 1997, thirty eight cases of Enneking's
stage ⅡB osteosarcoma in extremities, were treated with neoadjuvant chemotherapy by
modified T10 protocol of Rosen. Their mean age was 22 years old (8 months to 55
years). And average duration of follow up is 29 months(10 months to 88 months). The
preoperative chemotherapy consisted of high dose methotrexate(HDMTX)(above 12 years
old: 8 g/m2, below 12 years old: 12 g/m2),
adriamycin(ADR)(30 mg/m2/day×2), intra-arterial cisplatin(CDDP)(100
mg/m2) or ifosfamide(IFO)(1.8 g/m2/day×5). The
preoperative tailoring was performed according to the radiologic response after
chemotherapy. If the patient revealed good response, we continued the chemotherapy
next one more cycle and if not, sloped the chemotherapy or changed the cisplatin to
ifosfamide. The postoperative chemotherapy consisted of HDMTX, adriamycin, ifosfamide
or cisplatin with 4 cycles. According to the pathologic response to the pre-operative
chemotherapy, we use HDMTX, ADR, CDDP in good response group and HDMTX,
ADR, IFO in poor response group respectively,
Results : On the latest follow up, 27 patients were continuous disease free(CDF
27/38), 4 patients were alive with disease(AWD) and 6 patients were died of
disease(DOD) and 1 case was died of bone marrow and hepatic failure due to
complication of chemotherapy. According to Kaplan-Meier's plot, the overall 5 years
survival rate was 73.6%, and continuous disease free 5 years survival rate being 64%.
The comparison of continuous disease free survival rates between good radiologic
response group and poor response group showed 73% and 55%. The continuous disease
free survival rates according to the pathologic response in good response group and poor
were 90 % and 55%. During the chemotherapy, the most serious complications were
leukocytopenia and bone marrow failure. These were controled by granulocyte colony
stimulating factor(G-CSF) and leukotrophic agent. Other minor complications were
nausea, vomiting, headache and extrapyramidal symptom, which were easily managed by
simple conservative measure.
Conclusion : It was obtained that the overall 5 years survival rate was 73.6%, and
continuous disease free 5 years survival rate being 64% with modified T10 protocol.
키워드
Osteosarcoma; Neoadjuvant chemotherapy; Survival rate;
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