Current Concept of Treating High-grade Osteosarcoma

惡性骨肉癌之治療

陳威明(Wei-Ming Chen)

《Formosan Journal of Surgery》 42卷4期 (2009/08) Pp. 197-204

https://doi.org/10.29833/FJS.200908.0001

摘要

惡性骨肉癌是最常見的原發性惡性骨腫瘤。在1970年代之前，預後相當的差，且截肢率幾乎高達百分之百。然而，自從1976年開始使用“新輔助性化學治療”，存活率已大爲提高。目前以新輔助性化學治療後，將腫瘤做廣泛性切除與肢體重建，再加上手術後輔助性化學治療已成爲的標準方法。而影響到預後的因子，包括腫瘤體積，血中鹼性磷酸酶濃度，腫瘤壞死程度與是否合併遠端轉移。另外重要的是，再我們的研究中發現，病人在常規治療之前若接受局部推拿，也是造成較差預後的獨立因子。肢體保留的重建有許多種方法，一般分爲人工關節重建與生物學重建。我們傾向使用生物學重建因爲有較佳的功能與較長的使用壽命。另外，在台北榮總，我們使用了兩樣創新手術，“保留生長板與骨骺之腫瘤切除法”與“半骨皮質性腫瘤切除法”。均得到較佳的肢體功能，且均無腫瘤復發病例。經由這些努力，目前在我們醫院，高度惡性骨肉癌之五年存活率，已經高達74%，且大於95%的肢體可予以保留。以前認爲是個絕症的高度惡性骨肉癌，目前可以說是已變成大致可治癒的疾病了。

並列摘要

Osteosarcoma is the most common type of primary malignant bone cancer. Before the 1970's, the survival rate was dismal, and the amputation rate was nearly 100%. However, the outcome was improved after neoadjuvant chemotherapy was started in 1976. Nowadays, the formal treatment is neoadjuvant chemotherapy following wide excision with reconstruction and adjuvant chemotherapy, and several factors, such as size, serum alkaline phosphatase, tumor necrosis and metastasis, are related to the outcome. In our study. receiving previous manipvlative therapy was also an independent survival factor. A number of options that exist for limb-salvage reconstruction are classified as prosthetic and biological reconstructions, and we prefer the latter method because of better longevity and function. In Taipei Veterans General Hospital, we performed two new surgical procedures, ”transphyseal excision” and ”hemicortical excision”, which resulted in good functional outcome and no local recurrence of the tumor. As a result, the five-year survival rate was increased to 74%, and the limb salvage rate was more than 95% in our hospital, showing significant improvement. Osteosarcoma, which was known as a devastating disease in the past, now appears largely curable.

並列關鍵字

osteosarcoma ； outcome ； limb salvage