Abstract

Methotrexate containing chemotherapy is less commonly used for treatment of osteosarcoma in resource limited settings. We present our experience with the administration of high dose methotrexate (HDMTX) containing chemotherapy over a period of three years. Children between 1 and 14 years of age with newly diagnosed nonmetastatic extremity osteosarcoma, registered in Pediatric Oncology Department of a tertiary care cancer center in South India between 1st January 2016 and 31st December 2018 and receiving MAP chemotherapy were included. Patients in this study received HDMTX at 12 g/m². Twenty two patients were included. After neoadjuvant chemotherapy, 20 patients underwent surgery (limb salvage surgery in 16, amputation in 4). The median time from initiation of chemotherapy to surgery was 97.5 days. Eighteen of 22 patients (81.8%) completed planned chemotherapy in our cohort, one patient was lost to follow up after progression and three patients required change of chemotherapy due to toxicities. Of a total of 227 cycles of HDMTX infusions in 22 patients, delayed clearance occurred in 22 cycles (9.7%). Major toxicities were myelosuppression (30 episodes in 17 patients), blood stream infections (24 episodes in 15 patients) and mucositis (15 episodes in 10 patients). Hearing loss was documented in 7 patients. There was no treatment related mortality. Chemotherapy was completed in a median duration of 38.5 weeks. Administration of high dose methotrexate containing chemotherapy is feasible in pediatric patients with osteosarcoma, even in resource limited settings, if there are facilities for hydration, determination of methotrexate levels and good supportive care.

摘要

在资源有限的情况下，含甲氨蝶呤的化疗不太常用于治疗骨肉瘤。我们介绍了我们在三年内使用含高剂量甲氨蝶呤 (HDMTX) 化疗的经验。纳入 2016 年 1 月 1 日至 2018 年 12 月 31 日期间在印度南部一家三级护理癌症中心儿科肿瘤科登记并接受 MAP 化疗的新诊断非转移性肢体骨肉瘤的 1 至 14 岁儿童。本研究中的患者接受了 12 g/m ^{2的 HDMTX}. 包括 22 名患者。新辅助化疗后，20例患者接受了手术（保肢手术16例，截肢4例）。从开始化疗到手术的中位时间为 97.5 天。在我们的队列中，22 名患者中有 18 名 (81.8%) 完成了计划化疗，1 名患者在进展后失访，3 名患者因毒性需要改变化疗。在 22 名患者的总共 227 个 HDMTX 输注周期中，延迟清除发生在 22 个周期 (9.7%)。主要毒性为骨髓抑制（17 名患者 30 次发作）、血流感染（15 名患者 24 次发作）和粘膜炎（10 名患者中 15 次发作）。在 7 名患者中记录了听力损失。没有与治疗相关的死亡率。化疗的中位持续时间为 38.5 周。