The Clinical Efficacy Of Neoadjuvant Chemotherapy Combined With Limb Salvage Surgery For Osteosarcoma

Objective:To analyze neoadjuvant chemotherapy combined with limb salvage surgery treatment and prognosis of patients with osteosarcoma;Methods:(1) Atudy: Select hospitalized patients meet the criteria, between May 2005 to May2014 in the second set of the pathological diagnosis of bone disease diagnosed Hospital of Shanxi Medical University of osteosarcoma, parallel neoadjuvant chemotherapy and limb salvage surgery osteosarcoma patients treated with preoperative X-ray, CT, MRI and whole body bone scan and other tests found no distant metastasis. Collect data related to preoperative(clinical manifestations, imaging data, such as alkaline phosphatase measured values.(2) Treatment: Admission underwent tumor tissue biopsy or open surgical biopsy,pathological diagnosis after diagnosis of osteosarcoma, neoadjuvant chemotherapy(2-3times before surgery, postoperative 4-6 times), chemotherapy program: 2-3 cycles of preoperative and postoperative period 4-6, using AP program: namely doxorubicin(adriamycin) and cisplatin, after the 2-3 cycles of chemotherapy before surgery, in the patient’s body as circumstances permit conditions downstream, surgery + limb reconstruction surgery, again 4-6 cycles of chemotherapy.(3) Evaluate the efficacy of chemotherapy: After review of laboratory tests before chemotherapy again, change imaging studies, examining and comparing the size of the tumor lesion, tumor response to chemotherapy, evaluated the efficacy of chemotherapy.(4) Adverse reactions: monitoring patients with different adverse reactions tochemotherapy(5) Follow-up: subsequent periodic review and follow-up: Through careful preoperative data consolidation, regular follow-up, patients with postoperative results were observed: complications, 5-year disease-free survival, local recurrence rate and postoperative Evaluation of functional recovery. Limb salvage patients referring Enneking functional evaluation of limb function assessment criteria to evaluate postoperative limb function.The result:In this study, 57 patients underwent neoadjuvant chemotherapy and limb salvage surgery for osteosarcoma patients were followed up for 8-110 months, with an average follow-up time of 57 months. During follow-up, 57 patients among the 2-year survival rate72.4% 5-year survival rate of 60.5%, 10-year survival rate of 15.6%. After preoperative chemotherapy in patients with pain, discomfort and other symptoms were relieved, reduce swelling, tumor volume reduced to varying degrees, to alleviate local tenderness, local skin temperature reduction, texture hard, near the joint activity to improve; laboratory examination showed alkaline phosphatase value decreased, radiological examination showed the tumor reduced to varying degrees, the boundary becomes clear, alleviate bone destruction, calcification and bone formation increased periosteal reaction varying degrees of relief.In conclusion:Good response to neoadjuvant chemotherapy, which can effectively kill osteosarcoma small lesions, efficacy in patients with osteosarcoma significant, can effectively improve the survival rate of patients, neoadjuvant chemotherapy is the key to the implementation of limb salvage surgery, there is no system of standardized chemotherapy surgery is difficult to succeed; salvage treatment with neoadjuvant chemotherapy with the support of not only the patient can get a higher long-term survival, and improve the quality of life of patients,prosthetic replacement is currently osteosarcoma around the knee limb salvage therapy mainstream program, neoadjuvant chemotherapy combined with limb-sparing surgery is an ideal treatment for sarcoma limbs, we need further research and application.