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Kobys V. L. Treatment of large osteosarcoma in children: new approach [Електронний ресурс] / V. L. Kobys, V. F. Konovalenko, N. V. Repinа, T. S. Golovko, L.O. Gulak, T. O. Tarasova, E. V. Zaharycheva, O. F. Matyushok // Experimental oncology. - 2013. - Vol. 35, № 2. - С. 105-108. - Режим доступу: http://nbuv.gov.ua/UJRN/EOL_2013_35_2_9 Aim - to improve the treatment results of patients with locally advanced osteosarcoma with large volume using neoadjuvant chemotherapy (NACT) (ifosfamide at a dose of 18 g/ml) and planning of organ-conserving surgery by evaluating the state of tumor pseudocapsule. A study group included 46 children aged from 7 to 18 years, mean age - 12 years. In 68 % of the patients tumor volume was larger or significantly larger than 200 ml (from 27 to 2400 ml), mean tumor volume was 342 ml. All patients have been examined by X-ray radiography, CT, Doppler ultrasound. Convenient chemotherapy consisted of methotrexate at a dose of 12 g/ml, cisplatin (120 mg/ml) in combination with doxorubicin (75 mg/ml). If such chemotherapy was considered ineffective with the use of an algorithm for determination of chemotherapy efficacy, 2 cycles of chemotherapy with ifosfamide at a dose of 18 g/ml per course have been applied. At the stage of planning of organ-conserving surgery, the state of tumor pseudocapsule was analyzed. In 6 months post-operative chemotherapy was carried out with the use of methotrexate, cisplatin with doxorubicin, ifosfamide at the same doses. Myelotoxicity of ifosfamide treatment at a dose of 18 g/ml is comparable to that of to a course of doxorubicin + cisplatin: the depth of leucopenia was significantly higher (p << 0,05), the duration of agranulocytosis is similar after such therapies. In the study group, 69,6 % patients have reached grade 3 - 4 pathomorphosis. Organ-conserving surgery was performed in 86,9 % of the patients. Local tumor recurrence was registered in 15,2 % patients of the study group. 5-year relapse-free survival was achieved in 62 +- 10 % (p = 0,02), the overall 5-year survival - 76,5 +- 9 % (p = 0,02). Conclusions: introduction of ifosfamide at a dose of 18 g/ml in the treatment scheme of pediatric patients with locally advanced osteosarcoma along with individualization of pre-oper- g/ml in the treatment scheme of pediatric patients with locally advanced osteosarcoma along with individualization of pre-oper- g/ml in the treatment scheme of pediatric patients with locally advanced osteosarcoma along with individualization of pre-oper- ml in the treatment scheme of pediatric patients with locally advanced osteosarcoma along with individualization of pre-oper- in the treatment scheme of pediatric patients with locally advanced osteosarcoma along with individualization of pre-oper- in the treatment scheme of pediatric patients with locally advanced osteosarcoma along with individualization of pre-oper- in the treatment scheme of pediatric patients with locally advanced osteosarcoma along with individualization of pre-oper- osteosarcoma along with individualization of pre-oper along with individualization of pre-operative chemotherapy, pre-oper ative analysis of NACT efficacy and the state of tumor pseudocapsule during planning stage of organconserving surgery significantly improves efficacy of the therapy in patients with large tumor volume. | ||
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