The Clinical Response Analysis Of Femoral Arterial Infusion Chemotherapy Combine With Regional Vascular Block In The Lower Extremities Osteosarcoma

Objective:Osteosarcoma is the most common clinical primary malignant bone tumors,early chemotherapy is an important method to improve the long-term prognosis for patients;Arterial infusion chemotherapy can improve the concentration of chemotherapeutic drugs for tumor region.Further more,arterial infusion chemotherapy was widely applied in liver cancer,cervical cancer and osteosarcoma in recent years.In this article,we use a comparative study of regional vascular occlusion intraarterial chemotherapy(Femoral arterial infusion chemotherapy combined with regional vascular block,FAIC)and intravenous chemotherapy(Intravenous chemotherapy,IVC)in the treatment of lower limb osteosarcoma clinical curative effect evaluation,then analysis the clinical curative effect caused by the difference method in two groups.Method:According to inclusion criteria,39 lower limb osteosarcoma patients were enrolled when they visit the First Affiliated Hospital of Nanchang University from June 2014 to December 2016.They were divided into group FAIC and group IVC.21 cases in FAIC group were treated with cisplatin(CDDP120mgm-2)by femoral artery perfusion combined with adriamycin(ADM90mgm-2),ifosfamide(IFO2g m-2)intravenous chemotherapy;18 cases in IVCgroup(CDDP120mgm-2,ADM90mgm-2,by IFO2 g m-2)intravenous chemotherapy.Evaluate:(1)8h,72 h patients pain released,knee joint activity increased,tumor circumference reduced,and changes in osteosarcoma boundary definition,edema and imaging indexes of patients after chemotherapy between two groups;(2)Patients after chemotherapy in two groups of alkaline phosphatase(ALP)and bleeding in the limb salvage surgery,tumor necrosis rate between the two groups;(3)After two groups 2 years disease-free survival and the difference in 2 years survival rate,late complications;(4)High performance liquid chromatography(HPLC)was created to cisplatin plasma concentration in two methods.Results:(1)Pain relief were 3.47 ± 0.64,4.81 ± 0.81 after 8h and 72 h chemotherapy By FAIC,and the relieved in IVC group were 1.94 ±0.80,2.81±0.85(P < 0.01);Joint ROM of FAIC group and IVC group 8h,72 h after chemotherapy were increased to 20.95°±10.44°vs 13.33°±11.11°(P < 0.01);28.33±12.97°vs 17.50±12.27°(P < 0.01)significantly statistical differences between two groups.The FAIC group,8h,72 h later,the location of the maximum limb circumference were significantly less than the IVC administration group,P < 0.01.(2)After the treatment of FAIC in patients with X ray on osteosarcoma calcification,calcification of tumor wer increased more than IVC group,P < 0.05;alkaline phosphatase(ALP)decreased more than IVC group(P < 0.05),and the amount of bleeding limb in the operation of less than the IVC group(P < 0.05),the difference between the two groups;(3)Tissue reaction in group FAIC(good rate of tumor cell necrosis rate > 90%)accounted for66.67% in the group(14/21);good chemotherapy tissue reaction rate in IVC group was 55.56%(10/18);TUNEL:FAIC group can cause osteosarcoma cells large necrosis,IVC group chemotherapy showed spotty necrosis of uniform.(4)The total limb saving success rate of FAIC group and IVC group were 90.47% and 78.91%;FAIC group and IVC group 2 years disease-free survival rates were 70.58% and 64.28%,P=1.000;the 2 year survival rate was 88.23%,78.57%,p=0.698;the probability of FAIC group and IVC group can produce a transient nausea,vomiting,cold and other adverse reactions were 33%(group FAIC,7/21)and 38.8%(group IVC,7/18));the CTCAE scores of the two groups can produce organ damage,kidney damage(CTCAE grade = 2),bone marrow suppression and leukopenia;incidence rate 23.8%(group FAIC)and 27.7%(group IVC).(4)The successful model of a high performance liquid chromatography(HPLC),the detection accuracy,detection between and within a day;FAIC group and IVC group in plasma elimination half-life(t1/2)were 65.4h and 60.1h,the two largest group of cisplatin plasma concentrations were 29.13ug/ml,4.86ug/ml,followed by after administration article 1min and 30min;FAIC group at different plasma concentration and the time-cisplatin concentration area(AUC)were higher than IVC group,P < 0.05.Conclusion:Femoral arterial infusion chemotherapy combine with regional vascular block has better clinical efficacy in osteosarcoma,which not only improve better limb saving,but also advanced the survival rate and disease-free survival rate in the short-term contrast to IVC,its efficacy may be due to FAIC who improvedosteosarcoma cells gaoshun platinum concentration exposure.