目的:探讨三氧化二砷(arsenic trioxide,As2O3)联合吉西他滨及多西他赛治疗骨肉瘤肺转移的临床疗效.方法:收集26例对一线化疗药物耐药的骨肉瘤肺转移患者,男性14例,女性12例,年龄11～62岁,平均31.2岁,所有患者均接受过传统规范化疗后出现肺转移.应用As2O3(剂量为10 mg/d,d1 ～ 28)联合吉西他滨(剂量为800 mg/m2,d1、d8)及多西他赛(剂量为75 mg/m2,d8)每3周重复给药,每2个化疗疗程复查疗效.结果:接受化疗的患者总体有效率(CR+PR)为34.6％(9/26).中位随访时间28.2(1～48)个月,中位总生存期(OS)为16.7个月(95％CI:7.561 ～ 18.058)和中位无进展生存期(PFS)为10.3个月(95％CI:6.541～8.754),1、2和4年生存率分别是61.5％、38.4％和15.4％.治疗后最常见的不良反应为骨髓抑制,而常见的非血液学不良反应包括心脏毒性、消化道反应及肝肾功能异常,对症处理后均明显缓解.结论:As2O3联合吉西他滨及多西他赛作为二线化疗药物治疗骨肉瘤肺转移的近期临床疗效较好,且有较好的耐受性.%Objective: This study aims to investigate the clinical effects of arsenic trioxide (As2O3) combined with gemcitabine and docetaxel on the treatment of osteosarcoma pulmonary metastasis. Methods: Data on 26 osteosarcoma patients suffering from lung metastasis and exhibiting drug resistance to first-line chemotherapy were collected. The patients consisted of 14 males and 12 females. The ages ranged from 11 years to 62 years, with a mean age of 31.2 years. The patients received As2O3 (dose: 10 mg/d, Day 1 to Day 28) combined with gemcitabine (dose: 675 mg/m2, Days 1 and 8) and docetaxel (dose: 75 mg/m2, Day 8). This therapy was repeated every 3 weeks. Results: Patients who received chemotherapy showed an overall efficiency of 76.9% (complete response + partial response + stable disease). After a median follow-up of 28.2 months (48 months), the median overall survival time was calculated at 16.7 months [95% confidence interval (CI) 7.561 to 18.058], and the median progression-free survival was 10.3 months (95%CI 6.541 to 8.754). The 24- and 48-month survival rates reached 38.4% and 15.4%, respectively. Most commonly observed adverse reactions include myelosuppression, cardiotoxicity, digestive reactions, as well as liver and kidney damage. The patients' conditions were apparently relieved after symptomatic treatments. Conclusion: mhe combination of As2O3 with gemcitabine and docetaxel as second-line chemotherapeutic drugs for osteosarcoma cases with pulmonary metastasis exhibited satisfactory clinical short-term effects. These drugs were well tolerated.
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