Опыт применения неоадъювантной трехкомпонентной химиотерапии (цисплатин, доксорубицин, метотрексат) у молодых взрослых с остеосаркомой

Введение. Современное лечение остеосаркомы требует многокомпонентной терапии с включением предоперационной химиотерапии. Преимущества такой терапии заключаются в возможности оценки in vivo активности химиотерапевтических препаратов и создания условий для более абластичного хирургического вмешательства.

Цель исследования – проанализировать эффективность трехкомпонентной химиотерапии на основе комбинации доксорубицина, цисплатина и метотрексата у молодых взрослых с остеосаркомой. Материалы и методы. С 2022 по 2024 г. в Национальном медицинском исследовательском центре онкологии им. Н.Н. Блохина получили лечение 22 пациента от 18 до 42 лет (средний возраст – 30 лет) со злокачественными новообразованиями костей. Перед началом химиотерапии всем больным проведены морфологические и клиникорентгенологические исследования. Пациенты получили 2 курса неоадъювантной химиотерапии (доксорубицин + цисплатин + метотрексат) с последующим хирургическим этапом лечения.

Результаты. Полностью завершили неоадъювантную полихимиотерапию и этап локального контроля 16 пациентов, 12 из которых получили 2 курса химиотерапии по схеме МАР (доксорубицин + цисплатин + метотрексат). Полных ремиссий зарегистрировано не было. Стабилизация заболевания отмечена у 1 (8,3 %) пациента, частичный ответ – у 8 (66,6 %). Контроль за опухолью достигнут у 74,9 % пациентов. В 3 случаях выявлено прогрессирование заболевания. Хирургическое лечение выполнено в 10 (83,3 %) случаях, из них органосохраняющее – в 9 (75 %). Один пациент отказался от хирургического вмешательства, и ему был проведен радикальный курс дистанционной лучевой терапии. В 1 (8,3 %) случае отмечен лечебный патоморфоз IV степени, в 3 (25 %) – III степени, в 3 (25 %) – II степени, в 3 (25 %) – I степени, в 2 (16,7 %) он не определялся (отмечено прогрессирование заболевания).

Заключение. В ходе нашего исследования мы получили высокий уровень контроля над ростом опухоли (74,9 % случаев), но лечебный патоморфоз III–IV степени был достигнут лишь в 33,3 % случаев. Согласно полученным данным пиковая концентрация метотрексата не влияет на эффективность терапии. В перспективе целесообразно включить в исследуемую группу большее число пациентов, проанализировать безрецидивную и общую выживаемость, а также сравнить эффективность химиотерапии по схеме MAP с результатами химиотерапии в стандартном режиме (цисплатин + доксорубицин).

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