Химиотерапия взрослых больных с саркомами мягких тканей
В обзоре рассмотрены общие принципы цитостатического лечения взрослых больных с саркомами мягких тканей. Роль химиотерапии при этом заболевании на протяжении последних лет повышается. Hаиболее эффективными цитостатиками являются доксорубицин и ифосфамид, причем у обоих препаратов установлена зависим...
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| Опубліковано в: : | Онкологія |
|---|---|
| Дата: | 2000 |
| Автор: | |
| Формат: | Стаття |
| Мова: | Російська |
| Опубліковано: |
Iнститут експериментальної патології, онкології і радіобіології ім. Р. Є. Кавецького
2000
|
| Теми: | |
| Онлайн доступ: | https://nasplib.isofts.kiev.ua/handle/123456789/32929 |
| Теги: |
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Немає тегів, Будьте першим, хто поставить тег для цього запису!
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| Назва журналу: | Digital Library of Periodicals of National Academy of Sciences of Ukraine |
| Цитувати: | Химиотерапия взрослых больных с саркомами мягких тканей / Я.В. Шпарик // Онкологія. — 2000. — Т. 2, № 1. — С. 126-132. — Бібліогр.: 96 назв. — рос. |
Репозитарії
Digital Library of Periodicals of National Academy of Sciences of Ukraine| _version_ | 1860164420823416832 |
|---|---|
| author | Шпарик, Я.В. |
| author_facet | Шпарик, Я.В. |
| citation_txt | Химиотерапия взрослых больных с саркомами мягких тканей / Я.В. Шпарик // Онкологія. — 2000. — Т. 2, № 1. — С. 126-132. — Бібліогр.: 96 назв. — рос. |
| collection | DSpace DC |
| container_title | Онкологія |
| description | В обзоре рассмотрены общие принципы цитостатического лечения взрослых больных с саркомами мягких тканей. Роль химиотерапии при этом заболевании на протяжении последних лет повышается. Hаиболее эффективными цитостатиками являются доксорубицин и ифосфамид, причем у обоих препаратов установлена зависимость эффективности от дозы. Химиотерапию применяют как элемент радикального комбинированного лечения, а также как паллиативный метод при метастатическом процессе. При рабдомиосаркоме химиотерапия эффективна практически при любой стадии заболевания.
Chemotherapy has an increasing role in the therapy of soft tissue sarcomas. Meanwhile, chemotherapy of these tumors is frequently considered in general without taking into account the peculiar clinical features of various subtypes. Doxorubicin and ifosfamide are the most active drugs in the treatment of soft tissue sarcomas. Chemotherapy could be used both for radical and for palliative treatment. For rhabdomyosarcoma, chemotherapy is effective in all the stages of such disease.
|
| first_indexed | 2025-12-07T17:56:14Z |
| format | Article |
| fulltext |
Ê Î Ð Ï Î Ð À Ò È Â Í À ß È Í Ô Î Ð Ì À Ö È ß
ÎÍÊÎËÎÃÈß � Ò. 2 � ¹ 1�2 � 2000126
Ñàðêîìû ìÿãêèõ òêàíåé (ÑÌÒ) �îòíîñèòåëü-
íî ðåäêèé òèï îïóõîëåé, äëÿ êîòîðîãî õàðàêòåð-
íî çíà÷èòåëüíîå àíàòîìè÷åñêîå è ãèñòîëîãè÷åñ-
êîå ðàçíîîáðàçèå. Ó âçðîñëûõ ÑÌÒ ñîñòàâëÿþò
ìåíåå 1%, ó äåòåé � 7% âñåõ çëîêà÷åñòâåííûõ
îïóõîëåé. Âî Ëüâîâñêîé îáëàñòè â 1999 ã. çàðåãè-
ñòðèðîâàíî 58 ñëó÷àåâ ÑÌÒ (0,8% îò 7072 ïåð-
âè÷íûõ îíêîëîãè÷åñêèõ áîëüíûõ). Ñðåäè çàáîëåâ-
øèõ áûëî 2 (3,4%) äåòåé. Ïðåäïîëàãàåòñÿ, ÷òî â
ÑØÀ â 2000 ã. ÑÌÒ çàáîëåþò 8100 ÷åëîâåê (îêî-
ëî 2 ñëó÷àåâ íà 100 000 íàñåëåíèÿ), à óìðóò îò ýòîé
ïàòîëîãèè 4600 [50]. Håñêîëüêî ÷àùå áîëåþò ìóæ-
÷èíû. Ðàñïðåäåëåíèå çàáîëåâøèõ ïî âîçðàñòó òà-
êîâî: ìîëîæå 40 ëåò � 20%, 40�60 ëåò � 28%, ñòàð-
øå 60 ëåò � 52% áîëüíûõ [76].
Îïðåäåëåíèå ñòàäèè ÑÌÒ çàâèñèò îò ãèñòîëî-
ãè÷åñêîé ñòðóêòóðû, ñòåïåíè çëîêà÷åñòâåííîñòè,
ðàçìåðîâ ïåðâè÷íîé îïóõîëè, íàëè÷èÿ èëè îòñóò-
ñòâèÿ îòäàëåííûõ ìåòàñòàçîâ. Õîòÿ äî ñèõ ïîð íåò
ñòàíäàðòèçèðîâàííîé îáùåïðèíÿòîé ñèñòåìû
îïðåäåëåíèÿ ñòåïåíè çëîêà÷åñòâåííîñòè ÑÌÒ,
áîëüøèíñòâî ïàòîëîãîâ ñõîäÿòñÿ âî ìíåíèè, ÷òî
íàèáîëåå âàæíûìè êðèòåðèÿìè ÿâëÿþòñÿ äèôôå-
ðåíöèàöèÿ è âàñêóëÿðèçàöèÿ îïóõîëè, íàëè÷èå
íåêðîçîâ, êîëè÷åñòâî ìèòîçîâ.
Îáû÷íî ÑÌÒ èìåþò êëèíè÷åñêè áåññèìïòîì-
íîå òå÷åíèå. Ðåêîìåíäóþò ïðîâîäèòü áèîïñèþ
äëèòåëüíî ñóùåñòâóþùåé (áîëåå 4 íåä) îïóõîëè
ìÿãêèõ òêàíåé ðàçìåðîì áîëåå 5 ñì. Â ñâÿçè ñ îò-
íîñèòåëüíî ðåäêîé âûÿâëÿåìîñòüþ ÑÌÒ îòñóò-
ñòâóþò îïòèìàëüíûå îáùåïðèíÿòûå ñòàíäàðòû
ëå÷åíèÿ ýòîãî çàáîëåâàíèÿ ó âçðîñëûõ. Îäíàêî
îñíîâíûì ìåòîäîì ëå÷åíèÿ ÿâëÿåòñÿ õèðóðãè÷åñ-
êîå óäàëåíèå îïóõîëè (òàáë. 1).
Õèìèîòåðàïèþ (ÕÒ) � àäúþâàíòíóþ è íåî-
àäúþâàíòíóþ � ïðèìåíÿþò êàê â ðåæèìå ðàäè-
êàëüíîãî ëå÷åíèÿ áîëüíîãî ñ ÑÌÒ, òàê è â êà÷å-
ñòâå ïàëëèàòèâíîãî ìåòîäà.
Ïàëëèàòèâíàÿ ÕÒ. Ïðè ïðîâåäåíèè ìîíîõèìè-
îòåðàïèè ðàñïðîñòðàíåííûõ ÑÌÒ íàèáîëåå àêòèâ-
íûìè ïðåïàðàòàìè ÿâëÿþòñÿ èôîñôàìèä (òàáë. 2)
è äîêñîðóáèöèí (òàáë. 3), ýôôåêòèâíîñòü êîòîðûõ
ïðåâûøàåò 20%. Ïî ñâîäíûì ìíîãîëåòíèì äàííûì
EORTC (1742 ïàöèåíòà), 5-ëåòíÿÿ âûæèâàåìîñòü
áîëüíûõ ïîñëå ÕÒ äîêñîðóáèöèíîì ñîñòàâèëà 8,6%
[14]. ×òî êàñàåòñÿ àêòèâíîñòè èôîñôàìèäà, òî óñ-
òàíîâëåíî, ÷òî ýòîò öèòîñòàòèê îòíîñèòåëüíî ýô-
ôåêòèâåí ó 16% áîëüíûõ, êîòîðûå óæå ïîëó÷àëè
ïàëëèàòèâíóþ ÕÒ äîêñîðóáèöèíîì [61]. Î÷åíü
âàæíûì êàê ñ òåîðåòè÷åñêîé, òàê è ñ ïðàêòè÷åñ-
ß.Â. Øïàðèê
Ëüâîâñêèé ãîñóäàðñòâåííûé
îíêîëîãè÷åñêèé ðåãèîíàëüíûé
ëå÷åáíî-äèàãíîñòè÷åñêèé
öåíòð, Ëüâîâ, Óêðàèíà
Ëüâîâñêèé ãîñóäàðñòâåííûé
ìåäèöèíñêèé óíèâåðñèòåò
èì. Äàíèëà Ãàëèöêîãî, Ëüâîâ,
Óêðàèíà
Êëþ÷åâûå ñëîâà:
õèìèîòåðàïèÿ, ñàðêîìû
ìÿãêèõ òêàíåé, âçðîñëûå.
ÕÈÌÈÎÒÅÐÀÏÈß ÂÇÐÎÑËÛÕ
ÁÎËÜÍÛÕ Ñ ÑÀÐÊÎÌÀÌÈ
ÌßÃÊÈÕ ÒÊÀÍÅÉ
Ðåçþìå.  îáçîðå ðàññìîòðåíû îáùèå ïðèíöèïû öèòîñòàòè÷åñêîãî ëå-
÷åíèÿ âçðîñëûõ áîëüíûõ ñ ñàðêîìàìè ìÿãêèõ òêàíåé. Ðîëü õèìèîòåðà-
ïèè ïðè ýòîì çàáîëåâàíèè íà ïðîòÿæåíèè ïîñëåäíèõ ëåò ïîâûøàåòñÿ.
Hàèáîëåå ýôôåêòèâíûìè öèòîñòàòèêàìè ÿâëÿþòñÿ äîêñîðóáèöèí è
èôîñôàìèä, ïðè÷åì ó îáîèõ ïðåïàðàòîâ óñòàíîâëåíà çàâèñèìîñòü ýô-
ôåêòèâíîñòè îò äîçû. Õèìèîòåðàïèþ ïðèìåíÿþò êàê ýëåìåíò ðàäè-
êàëüíîãî êîìáèíèðîâàííîãî ëå÷åíèÿ, à òàêæå êàê ïàëëèàòèâíûé ìå-
òîä ïðè ìåòàñòàòè÷åñêîì ïðîöåññå. Ïðè ðàáäîìèîñàðêîìå õèìèîòå-
ðàïèÿ ýôôåêòèâíà ïðàêòè÷åñêè ïðè ëþáîé ñòàäèè çàáîëåâàíèÿ.
Òàáëèöà 1
Êëèíè÷åñêèå ïîäõîäû ê ëå÷åíèþ áîëüíûõ ñ ÑÌÒ
Ìåòîä Ãèñòîëîãè÷åñêàÿ ñòåïåíü çëîêà÷åñòâåííîñòè
ëå÷åíèÿ Äîáðîêà÷åñòâåííûå Hèçêàÿ Ñðåäíÿÿ Âûñîêàÿ
Îïåðàöèÿ + + + +
Îáëó÷åíèå - ± + +
Õèìèîòåðàïèÿ - - - +*
5-ëåòíÿÿ âûæèâàåìîñòü
îïåðèðîâàííûõ áîëüíûõ
100% 90% 80% 40�50%
*Õèìèîòåðàïèþ ïðèìåíÿþò ïðè ëèïîñàðêîìàõ âûñîêîé ñòåïåíè
çëîêà÷åñòâåííîñòè, çëîêà÷åñòâåííûõ ôèáðîçíûõ ãèñòèîöèòîìàõ,
ñèíîâèàëüíûõ ñàðêîìàõ, íåéðîñàðêîìàõ è àíãèîñàðêîìàõ.
Òàáëèöà 2
Ýôôåêòèâíîñòü ÕÒ èôîñôàìèäîì ïðè ðàñïðîñòðàíåííûõ ôîðìàõ ÑÌÒ
Èñòî÷-
íèê
Äîçà èôîñôàìèäà è äëè-
òåëüíîñòü ââåäåíèÿ (äíåé)
Êîëè÷åñòâî
áîëüíûõ
Îáùàÿ ýôôåê-
òèâíîñòü (%)
[39] 2,5�4,5 ã/ì
2
â ñóòêè (4 äíÿ) 20 35
[54] 2,5�3,5 ã/ì
2
â ñóòêè (5 äíåé) 11 36
[68] 2,5 ã/ì
2
â ñóòêè (5 äíåé) 16 31
[33] 1,25�2,5 ã/ì
2
â ñóòêè (5 äíåé) 13 38
[30] 2 ã/ì
2
â ñóòêè (6 äíåé) 28 39
[63] 1,8 ã/ì
2
â ñóòêè (5 äíåé) 18 22
[7] 2�2,5 ã/ì
2
â ñóòêè (4 äíÿ) 108 23
[88] 5�8 ã/ì
2
â ñóòêè (1 äåíü) 40 38
[19] 5 ã/ì
2
â ñóòêè (1 äåíü) 68 18
[57] 4 ã/ì
2
â ñóòêè (3 äíÿ) 36 33
[12] 2 ã/ì
2
â ñóòêè (7 äíåé) 45 17
[72] 5 ã/ì
2
â ñóòêè (1 äåíü) 50 3
[72] 3 ã/ì
2
â ñóòêè (3 äíÿ) 51 18
[74] 3,5 ã/ì
2
â ñóòêè (4 äíÿ) 38 39
[23] 2 ã/ì
2
â ñóòêè (7 äíåé) 48 38
Òàáëèöà 3
Ýôôåêòèâíîñòü ÕÒ äîêñîðóáèöèíîì ïðè ðàñïðîñòðàíåííûõ ôîðìàõ ÑÌÒ
Èñòî÷-
íèê
Äîçà äîêñîðóáèöèíà è
ïåðèîäè÷íîñòü ïðèìåíåíèÿ
Êîëè÷åñòâî
áîëüíûõ
Îáùàÿ ýôôåê-
òèâíîñòü (%)
[16] 60�90 ìã/ì
2
êàæäûå 3 íåä 130 34
[69] 25�70 ìã/ì
2
êàæäûå 3 íåä 82 28
[70] 60�75 ìã/ì
2
êàæäûå 3 íåä 49 31
[83] 70 ìã/ì
2
êàæäûå 3 íåä 66 27
[17] 70 ìã/ì
2
êàæäûå 3 íåä 93 19
[17] 15 ìã/ì
2
åæåíåäåëüíî 92 16
[32] 20�25 ìã/ì
2
êàæäûå 3 íåä 15 13
[67] 75 ìã/ì
2
êàæäûå 3 íåä 83 25
ÎÍÊÎËÎÃÈß � Ò. 2 � ¹ 1�2 � 2000 127
Ê Î Ð Ï Î Ð À Ò È Â Í À ß È Í Ô Î Ð Ì À Ö È ß
êîé òî÷êè çðåíèÿ ÿâëÿåòñÿ ïîäòâåðæäåíèå ÷åòêîé
çàâèñèìîñòè ýôôåêòèâíîñòè äîêñîðóáèöèíà è
èôîñôàìèäà îò äîçû. Ýòî ñîãëàñóåòñÿ ñ äàííûìè
îòäåëåíèÿ õèìèîòåðàïèè íàøåãî îíêîöåíòðà: çà
ïîñëåäíèå 5 ëåò ïðîâåäåíî ëå÷åíèå 22 áîëüíûõ
ÑÌÒ. Ó 3 èç íèõ äîñòèãíóòà ÷àñòè÷íàÿ ðåãðåññèÿ
îïóõîëè. Ýòè áîëüíûå ïîëó÷àëè äîêñîðóáèöèí â
äîçå íå íèæå 70 ìã/ì2, à 2 èç íèõ � êðîìå òîãî,
èôîñôàìèä â îáùåé äîçå íå íèæå 6 ã/ì2. Hà äîçî-
çàâèñèìîñòè ýôôåêòà îñíîâàíû ïðîâîäèìûå â íà-
ñòîÿùåå âðåìÿ èññëåäîâàíèÿ âûñîêîäîçîâîé ÕÒ ñ
ïåðåñàäêîé êîñòíîãî ìîçãà ïðè ÑÌÒ [41, 92].
Äðóãèå öèòîñòàòèêè ÿâëÿþòñÿ ýôôåêòèâíûìè
ìåíåå ÷åì ó 20% áîëüíûõ. Ñðåäè íèõ äàêàðáàçèí
(15�20%) [24], öèêëîôîñôàìèä (8%) [19], ìåòîòðåê-
ñàò (15�20%) [4, 89], âèíêðèñòèí (12%) [55, 85],
öèñïëàòèí (10�15%) [22, 44, 90], êàðáîïëàòèí (12%)
[49].  íàñòîÿùåå âðåìÿ èçó÷àåòñÿ êëèíè÷åñêàÿ ðîëü
íîâûõ öèòîñòàòèêîâ � ïàêëèòàêñåëà [10, 28], äîöå-
òàêñåëà [34, 51], òîïîòåêàíà [21], ãåìöèòàáèíà [3, 66],
ðàëòèòðèêñåäà [15] è ò.ä. Îäíàêî èõ àêòèâíîñòü, ïî
ïðåäâàðèòåëüíûì äàííûì, íå ïðåâûøàåò àêòèâ-
íîñòü äîêñîðóáèöèíà è èôîñôàìèäà.
Hà ïðàêòèêå ìîíîõèìèîòåðàïèþ ðåêîìåíäó-
þò ïðèìåíÿòü òîëüêî ïðè ïàëëèàòèâíîì ëå÷åíèè.
Îïòèìàëüíîé äîçîé äîêñîðóáèöèíà ÿâëÿåòñÿ 60�
90 ìã/ì2 â êà÷åñòâå 48�96-÷àñîâûõ èíôóçèé (â
öåëÿõ ñíèæåíèÿ ðèñêà êàðäèîòîêñè÷íîñòè) êàæ-
äûå 3 íåä [26]. Èôîñôàìèä áîëåå àêòèâåí ïðè
ïðîâåäåíèè êîðîòêèõ èíôóçèé (îò 1 äî 4 ÷) ïî
ñðàâíåíèþ ñ äëèòåëüíûìè.  ýòîì ñëó÷àå åãî ýô-
ôåêòèâíîñòü òàêàÿ æå, êàê äîêñîðóáèöèíà [8].
Ðåêîìåíäóåìàÿ äîçà èôîñôàìèäà � 8�14 ã/ì2 â
òå÷åíèå 4�5 äíåé. Ýôôåêòèâíîñòü èôîñôàìèäà â
òàêèõ äîçàõ ïðèáëèçèòåëüíî îäèíàêîâà â êà÷åñòâå
ïåðâîé è âòîðîé (ïîñëå ÕÒ äîêñîðóáèöèíîì) ëè-
íèè ëå÷åíèÿ. Èôîñôàìèä â áîëåå âûñîêèõ äîçàõ
ýôôåêòèâåí ïî÷òè ó 30% áîëüíûõ, äàæå ïðè ðå-
çèñòåíòíîñòè îïóõîëè ê åãî äåéñòâèþ â íèçêèõ
äîçàõ [57]. Ïðè ñðàâíåíèè ýôôåêòèâíîñòè öèêëî-
ôîñôàìèäà è èôîñôàìèäà (èññëåäîâàíèå EORTC)
óñòàíîâëåíî, ÷òî ýôôåêòèâíîñòü èôîñôàìèäà
âûøå [19]. Â íàñòîÿùåå âðåìÿ EORTC ïðîâîäèò
ñðàâíèòåëüíîå ðàíäîìèçèðîâàííîå èññëåäîâàíèå
àêòèâíîñòè èôîñôàìèäà è äîêñîðóáèöèíà â ðàç-
ëè÷íûõ äîçàõ (ïëàíèðóåòñÿ îõâàòèòü íå ìåíåå
780 áîëüíûõ) [52].
Ó÷èòûâàÿ, ÷òî äîêñîðóáèöèí è èôîñôàìèä �
íàèáîëåå àêòèâíûå öèòîñòàòèêè, êëèíèöèñòû èç
ìíîãèõ îíêîëîãè÷åñêèõ öåíòðîâ èññëåäóþò ýôôåê-
òèâíîñòü èõ êîìáèíàöèè â ðàçíûõ äîçàõ ïðè ïàë-
ëèàòèâíîé ÕÒ ïî ïîâîäó ÑÌÒ (òàáë. 4). ×àùå ðå-
êîìåíäóþò ïðèìåíÿòü äîêñîðóáèöèí â äîçå 60�
90 ìã/ì2, èôîñôàìèä � â äîçå 5�10 ã/ì2 íà
ïðîòÿæåíèè 3�5 äíåé. Ýôôåêòèâíîñòü òàêîãî ëå÷å-
íèÿ ñîñòàâëÿåò 35�65%. Îäíàêî ïðè ýòîì äîâîëü-
íî âûñîêà åãî îáùàÿ òîêñè÷íîñòü. Ïîêà íåò åäè-
íîãî ìíåíèÿ, ïîâûøàåòñÿ ëè ýôôåêòèâíîñòü
êîìáèíèðîâàííîé ÕÒ ïðè äîïîëíèòåëüíîì
èñïîëüçîâàíèè äàêàðáàçèíà. Èòàëüÿíñêèå îíêîëî-
ãè â êîìáèíàöèè ñ èôîñôàìèäîì âìåñòî äîêñîðó-
áèöèíà ñ óñïåõîì ïðèìåíÿþò ýïèðóáèöèí [42]. Íà
ïðîòÿæåíèè ïîñëåäíèõ ëåò àêòèâíî èçó÷àþò ýô-
ôåêòèâíîñòü êîìáèíàöèè MAID (òàáë. 5) [25, 31,
38]. Ðåçóëüòàòû ëå÷åíèÿ äåòåé ñ ÑÌÒ ñóùåñòâåí-
íî óëó÷øèëèñü ïîñëå çàìåíû êîìáèíàöèè VACA
íà VAIA (âèíêðèñòèí + äîêñîðóáèöèí + öèêëî-
ôîñôàìèä/èôîñôàìèä + àêòèíîìèöèí D) � 5-ëåò-
íÿÿ âûæèâàåìîñòü ïîâûñèëàñü ñ 44 äî 60% [56].
Åñëè îáîáùèòü ìíîãî÷èñëåííûå ðåçóëüòàòû
ïðîâåäåíèÿ ïàëëèàòèâíîé ÕÒ ïðè ÑÌÒ, òî îêà-
æåòñÿ, ÷òî ýôôåêòèâíîñòü ìîíîòåðàïèè ñîñòàâ-
ëÿåò 15�30%, à êîìáèíèðîâàííîé � 20�50%. Îä-
íàêî ïîëíàÿ ðåãðåññèÿ îïóõîëè íàáëþäàåòñÿ äî-
âîëüíî ðåäêî. Êðîìå òîãî, ìíîãèå êëèíèöèñòû
îòðèöàþò âëèÿíèå êîìáèíèðîâàííîé ÕÒ íà ïî-
êàçàòåëè äëèòåëüíîé âûæèâàåìîñòè (òàáë. 6). Óñ-
òàíîâëåíî, ÷òî ïðîâåäåíèå ÕÒ ïîñëå íåóäà÷è ëå-
÷åíèÿ äîêñîðóáèöèíîì è/èëè èôîñôàìèäîì íå-
öåëåñîîáðàçíî. Îäíàêî, êàê óêàçûâàëîñü ðàíåå,
èôîñôàìèä â âûñîêèõ äîçàõ ýôôåêòèâåí ó òåõ
áîëüíûõ, êîòîðûå ïåðåä ýòèì ïîëó÷àëè èôîñôà-
ìèä èëè äîêñîðóáèöèí â íèçêèõ äîçàõ.
Àäúþâàíòíàÿ ÕÒ.  íà÷àëå 70-õ ãîäîâ óñòàíîâ-
ëåíà ýôôåêòèâíîñòü àäúþâàíòíîé ÕÒ ïðè ðàêå
ìîëî÷íîé æåëåçû è îñòåîñàðêîìå. Ýòî ñòàëî òåî-
ðåòè÷åñêèì îáîñíîâàíèåì äëÿ ïðèìåíåíèÿ ýòîãî
ìåòîäà ó áîëüíûõ ñ ÑÌÒ, ïðè êîòîðûõ ïðîãðåñ-
ñèðîâàíèå çàáîëåâàíèÿ è ñìåðòü ïîñëå ðàäèêàëü-
íîãî ëå÷åíèÿ îáóñëîâëåíû â áîëüøèíñòâå ñëó÷à-
åâ íàëè÷èåì îòäàëåííûõ ìåòàñòàçîâ.  òàáë. 7
ïðåäñòàâëåíû äàííûå ðàíäîìèçèðîâàííûõ èññëå-
äîâàíèé àäúþâàíòíîé ÕÒ ïðè ÑÌÒ.
Òàáëèöà 4
Ýôôåêòèâíîñòü ÕÒ êîìáèíàöèåé äîêñîðóáèöèíà (èëè ýïèðóáèöèíà*)
è èôîñôàìèäà ïðè ðàñïðîñòðàíåííûõ ôîðìàõ ÑÌÒ
Èñòî÷-
íèê
Äîêñîðóáè-
öèí (ìã/ì
2
)
Èôîñôà-
ìèä (ã/ì
2
)
Êîëè÷åñòâî
áîëüíûõ
Ýôôåêòèâ-
íîñòü (%)
 òîì ÷èñëå ïîë-
íûõ ðåãðåññèé (%)
[64] 40 5 28 7 1
[64] 60 5 22 41 2
[84] 50 5 175 35 15
[58] 60 5 42 36 3
[94] 60 10 44 43 6
[87] 75 5 104 45 10
[92] 50 5 134 20 4
[92] 75 5 128 21 2
[11] 60 7,5 40 38 15
[60] 90 10 31 55 13
[62] 50 12 56 31 -
[73] 110* 10 39 59 13
[79] 90* 12,5 46 52 22
Òàáëèöà 5
Âàðèàíòû êîìáèíàöèè MAID â ëå÷åíèè áîëüíûõ ÑÌÒ
Ñõåìà I âàðèàíò** II âàðèàíò***
MAID* Äîçû ïðåïàðàòîâ â ìã/ì
2
, â/â
Èôîñôàìèä 6000 (ñ 1-ãî ïî 3-é äåíü öèêëà) 7500 (1-é äåíü)
Ìåñíà 10 000 (ñ 1-ãî ïî 4-é äåíü öèêëà) 7500 (1-é äåíü)
Äîêñîðóáèöèí 60 (ñ 1-ãî ïî 4-é äåíü öèêëà) 60 (1-é äåíü)
Äàêàðáàçèí 1000 (ñ 1-ãî ïî 4-é äåíü öèêëà) 900 (1-é äåíü)
* Ïðèìåíÿþò êàæäûå 3 íåä.
** Ïðèâåäåíû ñóììàðíûå äîçû öèòîñòàòèêîâ, êîòîðûå ââîäÿò
ìåòîäîì íåïðåðûâíîé â/â èíôóçèè.
*** Öèòîñòàòèêè ââîäÿò ïóòåì êðàòêîâðåìåííîé â/â èíôóçèè.
Ê Î Ð Ï Î Ð À Ò È Â Í À ß È Í Ô Î Ð Ì À Ö È ß
ÎÍÊÎËÎÃÈß � Ò. 2 � ¹ 1�2 � 2000128
Èññëåäîâàòåëè èç Áîðäî, à òàêæå èç Îðòîïåäè-
÷åñêîãî èíñòèòóòà Rizzoli (Áîëîíüÿ) äîñòèãëè äî-
ñòîâåðíîãî óëó÷øåíèÿ ïîêàçàòåëåé äëèòåëüíîé âû-
æèâàåìîñòè ïîñëå àäúþâàíòíîé ÕÒ ïî ñõåìå
CyVADIC, äîêñîðóáèöèíîì [45, 78] èëè êîìáèíà-
öèåé ýïèðóáèöèíà è èôîñôàìèäà [43] ñîîòâåò-
ñòâåííî. Ñëåäóåò ó÷èòûâàòü çíà÷èòåëüíûå ðàçëè-
÷èÿ ìåæäó ãðóïïàìè áîëüíûõ â çàâèñèìîñòè îò
ëîêàëèçàöèè è ãèñòîëîãè÷åñêîãî òèïà îïóõîëè â
êàæäîì èññëåäîâàíèè. Êðîìå òîãî, â áîëüøèíñòâå
ðàíäîìèçèðîâàííûõ èññëåäîâàíèé ïðîâîäèëè
òîëüêî ìîíîòåðàïèþ äîêñîðóáèöèíîì â ñóáîïòè-
ìàëüíûõ äîçàõ. Ïóáëèêàöèé î ðåçóëüòàòàõ ðàíäî-
ìèçèðîâàííûõ èññëåäîâàíèé ïðèìåíåíèÿ êîì-
áèíàöèè äîêñîðóáèöèíà è èôîñôàìèäà â îïòè-
ìàëüíûõ äîçàõ, à òàêæå êîìáèíàöèè MAID
íåäîñòàòî÷íî. Hå èñêëþ÷åíî, ÷òî òàêîå ëå÷åíèå
áûëî áû áîëåå ýôôåêòèâíûì.  ÷àñòíîñòè, ñîãëàñ-
íî ïðåäâàðèòåëüíûì äàííûì èòàëüÿíñêèõ îíêî-
ëîãîâ, àäúþâàíòíàÿ ÕÒ ýïèðóáèöèíîì (ïî 60 ìã/ì2
2 äíÿ ïîäðÿä) è èôîñôàìèäîì (ïî 1,8 ã/ì2 5 äíåé
ïîäðÿä) ïîä çàùèòîé êîëîíèåñòèìóëèðóþùåãî
ôàêòîðà (G-CSF ïî 300 ìêã/äåíü) ïîçâîëèëà ñó-
ùåñòâåííî óëó÷øèòü ïîêàçàòåëè âûæèâàåìîñòè
áîëüíûõ ïîñëå îïåðàòèâíîãî âìåøàòåëüñòâà [43].
Håñêîëüêî ãðóïï êëèíèöèñòîâ ïðîâåëè ìåòà-
àíàëèç îïóáëèêîâàííûõ ðåçóëüòàòîâ ðàíäîìèçè-
ðîâàííûõ èññëåäîâàíèé. Òàê, ïî äàííûì 11 èñ-
ñëåäîâàíèé, êîòîðûå ïðîâåëè M.M. Zalupski è ñî-
àâòîðû [96], äëèòåëüíàÿ âûæèâàåìîñòü ïîñëå
àäúþâàíòíîé ÕÒ ÑÌÒ ïîâûñèëàñü ñ 71 äî 81%
(ð = 0,0005), à áåçðåöèäèâíàÿ âûæèâàåìîñòü � ñ
53 äî 68% (ð = 0,00001) [96]. J.F. Tierney è ñîàâòî-
ðû [91], êîòîðûå ïðîàíàëèçèðîâàëè ðåçóëüòàòû
14 èññëåäîâàíèé (1546 áîëüíûõ), îïðåäåëèëè, ÷òî
àäúþâàíòíàÿ ÕÒ ñïîñîáñòâóåò ïîâûøåíèþ ïîêà-
çàòåëåé 2- è 5-ëåòíåé âûæèâàåìîñòè (ð = 0,044 è
0,0002 ñîîòâåòñòâåííî).
Åùå áîëüøåå çíà÷åíèå èìååò àíàëèç äàííûõ
îáñëåäîâàíèÿ êàæäîãî ïàöèåíòà èç óïîìÿíóòûõ
14 ðàíäîìèçèðîâàííûõ èññëåäîâàíèé [82].
Ìåäèàíà ñðîêà íàáëþäåíèÿ ñîñòàâèëà 9,4 ãîäà.
Îêàçàëîñü, ÷òî ïðèìåíåíèå àäúþâàíòíîé ÕÒ íà
îñíîâå äîêñîðóáèöèíà óâåëè÷èëî âðåìÿ äî ïîÿâ-
Òàáëèöà 6
Ðàíäîìèçèðîâàííûå èññëåäîâàíèÿ ýôôåêòèâíîñòè ÕÒ ïðè ðàñïðîñòðàíåííûõ ôîðìàõ ÑÌÒ
Èññëåäîâàòåëü-
ñêàÿ ãðóïïà
Ðåæèì ÕÒ
Êîëè÷åñòâî
áîëüíûõ
Ýôôåêòèâ-
íîñòü (%)
Óëó÷øàþòñÿ ëè ïîêàçàòåëè
ýôôåêòèâíîñòè ëå÷åíèÿ?
Óëó÷øàþòñÿ ëè ïîêàçàòåëè
îáùåé âûæèâàåìîñòè?
ECOG [83] Äîêñîðóáèöèí 200 27 - -
Äîêñîðóáèöèí/âèíêðèñòèí 19 Håò Håò
Öèêëîôîñôàìèä/àêòèíîìèöèí D/âèíêðèñòèí 11 Håò Håò
ECOG [17] Äîêñîðóáèöèí (70 ìã/ì
2
) 275 18 - -
Äîêñîðóáèöèí (45 ìã/ì
2
) 16 Håò Håò
Äîêñîðóáèöèí/äàêàðáàçèí 30 Äà Håò
ECOG [18] Äîêñîðóáèöèí 298 17 - -
Äîêñîðóáèöèí/âèíäåñèí 18 Håò Håò
ECOG [36] Äîêñîðóáèöèí 262 20 - -
Äîêñîðóáèöèí/èôîñôàìèä 34 Äà Håò
Äîêñîðóáèöèí/ìèòîìèöèí Ñ/öèñïëàòèí 32 Äà Håò
SWOG [9] Äîêñîðóáèöèí/äàêàðáàçèí 276 33 - -
Äîêñîðóáèöèí/öèêëîôîñôàìèä/äàêàðáàçèí 34 Håò Håò
Äîêñîðóáèöèí/àêòèíîìèöèí D/äàêàðáàçèí 24 Håò Håò
EORTC [81] Äîêñîðóáèöèí 663 23 - -
Äîêñîðóáèöèí/èôîñôàìèä 28 Håò Håò
Äîêñîðóáèöèí/âèíêðèñòèí/öèêëîôîñôàìèä/
àêòèíîìèöèí D
28 Håò Håò
ISSG [5] Äîêñîðóáèöèí/äàêàðáàçèí 340 17 - -
Äîêñîðóáèöèí/èôîñôàìèä/äàêàðáàçèí/ìåñíà 32 Äà Håò
Òàáëèöà 7
Ðàíäîìèçèðîâàííûå èññëåäîâàíèÿ àäúþâàíòíîé ÕÒ ÑÌÒ
Èñòî÷- Ðåæèì ÕÒ Êîëè÷åñòâî % áåçðåöèäèâíîé âûæèâàåìîñòè % îáùåé âûæèâàåìîñòè
íèê áîëüíûõ áåç àäúþ-
âàíòíîé ÕÒ
ïîñëå àäúþ-
âàíòíîé ÕÒ
p áåç àäúþ-
âàíòíîé ÕÒ
ïîñëå àäúþ-
âàíòíîé ÕÒ
p
[20] Äîêñîðóáèöèí/öèêëîôîñôàìèä/âèíêðèñòèí/äàêàðáàçèí 468 43 56 0,007 56 63 NS
[78] Äîêñîðóáèöèí/öèêëîôîñôàìèä/âèíêðèñòèí/äàêàðáàçèí 59 16 57 p < 0,01 53 87 p < 0,01
[35] Äîêñîðóáèöèí/âèíêðèñòèí/äàêàðáàçèí/àêòèíîìèöèí D 61 68 65 NS 70 70 NS
[13] Äîêñîðóáèöèí/öèêëîôîñôàìèä/âèíêðèñòèí/àêòèíîìèöèí D 43 35 54 < 0,05 46 65 NS
[80] Äîêñîðóáèöèí/öèêëîôîñôàìèä/ìåòîòðåêñàò 31 49 77 0,075 58 68 NS
[47] Äîêñîðóáèöèí/öèêëîôîñôàìèä/ìåòîòðåêñàò 22 47 92 0,01 61 82 NS
[48] Äîêñîðóáèöèí/öèêëîôîñôàìèä/ìåòîòðåêñàò 15 - - - 100 47 0,06
[29] Äîêñîðóáèöèí/öèêëîôîñôàìèä/ìåòîòðåêñàò 67 28 54 < 0,05 60 54 NS
[43] Ýïèðóáèöèí/èôîñôàìèä 104 37 51 0,008 54 67 0,002
[2] Äîêñîðóáèöèí 181 56 62 NS 65 68 NS
[6] Äîêñîðóáèöèí 181 56 62 NS 65 68 NS
[71] Äîêñîðóáèöèí 156 47 59 NS 52 60 NS
[37] Äîêñîðóáèöèí 119 54 56 NS 74 78 NS
[45] Äîêñîðóáèöèí 77 45 73 < 0,05 70 91 < 0,05
[59] Äîêñîðóáèöèí 47 - - NS - - NS
NS � ðàçëè÷èÿ íåäîñòîâåðíû.
ÎÍÊÎËÎÃÈß � Ò. 2 � ¹ 1�2 � 2000 129
Ê Î Ð Ï Î Ð À Ò È Â Í À ß È Í Ô Î Ð Ì À Ö È ß
ëåíèÿ îòäàëåííûõ ìåòàñòàçîâ íà 10% (ñ 60 äî 70%,
ð = 0,0003), ìåñòíûõ ðåöèäèâîâ � íà 6% (ñ 75 äî
81%, ð = 0,024), äëèòåëüíîñòü áåçðåöèäèâíîãî
ïåðèîäà � íà 13% (ñ 45 äî 58%, ð = 0,000008), à
áåçðåöèäèâíóþ âûæèâàåìîñòü � íà 11% (ñ 40 äî
51%, ð = 0,00008), ÷òî, ïî ìíåíèþ àâòîðîâ, ÿâëÿ-
åòñÿ îñíîâîé äëÿ ïîâûøåíèÿ îáùåé âûæèâàåìî-
ñòè. Ýòîò ïîêàçàòåëü óëó÷øèëñÿ íà 5% [82].
Íà îñíîâàíèè ðåçóëüòàòîâ ðàíäîìèçèðîâàííûõ
èññëåäîâàíèé è ìåòààíàëèçà, âåäóùèå êëèíèöèñòû
ïîëàãàþò, ÷òî àäúþâàíòíàÿ ÕÒ ïîêà íå ìîæåò ñ÷è-
òàòüñÿ ñòàíäàðòíûì ìåòîäîì ëå÷åíèÿ ïðè ëîêàëü-
íûõ ôîðìàõ ÑÌÒ. Ýòîò ìåòîä ëå÷åíèÿ ìîæíî ïðè-
ìåíÿòü â äàëüíåéøåì òîëüêî ó áîëüíûõ ñ íåáëàãî-
ïðèÿòíûìè ïðîãíîñòè÷åñêèìè ôàêòîðàìè (îïóõîëü
áîëüøå 5 ñì, âûñîêàÿ ñòåïåíü èíâàçèè) [76].
Håîàäúþâàíòíàÿ ÕÒ. Ïðåäîïåðàöèîííàÿ ÕÒ
ñïîñîáíà óëó÷øèòü ðåçóëüòàòû ëå÷åíèÿ ÑÌÒ ïó-
òåì ñíèæåíèÿ ðèñêà ïðîãðåññèðîâàíèÿ îïóõîëè è
ýëèìèíàöèè ñóáêëèíè÷åñêèõ ìåòàñòàçîâ. Êðîìå
òîãî, íåîàäúþâàíòíàÿ ÕÒ ìîæåò îêàçûâàòü àääè-
òèâíîå èëè ñèíåðãè÷åñêîå äåéñòâèå ïðè ïðîâåäå-
íèè ïåðåäîïåðàöèîííîé ëó÷åâîé òåðàïèè è òàêèì
îáðàçîì ïðåâðàùàòü íåîïåðàáåëüíûå îïóõîëè â
îïåðàáåëüíûå [27]. Håîàäúþâàíòíàÿ ÕÒ ÿâëÿåòñÿ
ñòàíäàðòíûì ìåòîäîì ëå÷åíèÿ äåòåé ñ ðàáäîìèî-
ñàðêîìîé, îñòåîñàðêîìîé è ñàðêîìîé Þèíãà.
Ó âçðîñëûõ ýòîò ïîäõîä ïîêà òîëüêî èññëåäóþò.
Håñêîëüêî èññëåäîâàíèé â ýòîì íàïðàâëåíèè
ïðîâîäèëîñü â ÑØÀ íà÷èíàÿ ñ 1974 ã. Íåäàâíî
ñîîáùàëîñü î ðåçóëüòàòàõ äâóõ èññëåäîâàíèé, ñî-
ãëàñíî êîòîðûì ýôôåêòèâíîñòü íåîàäúþâàíòíîé
ÕÒ ñîñòàâèëà 24�27% [75, 77]. ×àñòîòà ïîñëåîïå-
ðàöèîííûõ îñëîæíåíèé íå çàâèñåëà îò ïðîâåäåíèÿ
íåîàäúþâàíòíîé ÕÒ [65]. Èçâåñòíû ðåçóëüòàòû
åäèíñòâåííîãî ïîêà èññëåäîâàíèÿ, â êîòîðîì ñ òà-
êîé öåëüþ ïðèìåíÿëè èôîñôàìèä â êîìáèíàöèè ñ
äîêñîðóáèöèíîì (à òàêæå öèñïëàòèíîì). Ýôôåê-
òèâíîñòü ëå÷åíèÿ ñîñòàâèëà 43% [93]. Ñîãëàñíî
íåäàâíî îïóáëèêîâàííûì äàííûì ñêàíäèíàâñêèõ
îíêîëîãîâ, íåîàäúþâàíòíàÿ ÕÒ óëó÷øàåò ðåçóëü-
òàòû âûæèâàåìîñòè áîëüíûõ ÑÌÒ [40].
Èíòåðåñíûì íàïðàâëåíèåì â ëå÷åíèè ÑÌÒ
ÿâëÿåòñÿ óäàëåíèå ìåòàñòàçîâ â ëåãêèõ [1]. Ñîãëàñ-
íî ïðåäñòàâëåííûì íà êîíôåðåíöèè ASCO â
1999 ã. ñâîäíûì äàííûì EORTC, ó áîëüíûõ ñ ìå-
òàñòàçàìè òîëüêî â ëåãêèõ ýôôåêòèâíîñòü ëå÷å-
íèÿ âûøå, ÷åì ó ïàöèåíòîâ ñ ìåòàñòàçàìè äðóãîé
ëîêàëèçàöèè, � 31 ïðîòèâ 23% [46]. Ïðåäïîëàãà-
åòñÿ, ÷òî ÕÒ (â ÷àñòíîñòè, íåîàäúþâàíòíàÿ) ìî-
æåò óëó÷øàòü ðåçóëüòàòû ëå÷åíèÿ áîëüíûõ ñ ìå-
òàñòàçàìè â ëåãêèõ. Ýòîé ïðîáëåìå ïîñâÿùåíû äâà
ïðîâîäÿùèõñÿ â íàñòîÿùåå âðåìÿ ðàíäîìèçèðî-
âàííûõ èññëåäîâàíèÿ EORTC [52].
Îñîáåííîñòè ëå÷åíèÿ áîëüíûõ ñ îòäåëüíûìè
òèïàìè ÑÌÒ. Êàê óæå îòìå÷àëîñü, ðàçëè÷àþò
ÑÌÒ íåñêîëüêèõ äåñÿòêîâ ïîäòèïîâ â çàâèñèìî-
ñòè îò ãèñòîëîãè÷åñêîé ñòðóêòóðû è ëîêàëèçàöèè.
 ðàíäîìèçèðîâàííûõ èññëåäîâàíèÿõ ýòè ïîäòè-
ïû ÷àùå âñåãî àíàëèçèðóþò âìåñòå. Îäíàêî ìíî-
ãèå àâòîðû îòìå÷àþò îñîáåííîñòè ëå÷åíèÿ ïðè
ðàçëè÷íûõ òèïàõ ÑÌÒ. Òàê, íàèìåíåå ÷óâñòâè-
òåëüíîé ê ÕÒ ñðåäè ÑÌÒ ÿâëÿåòñÿ, î÷åâèäíî,
ëåéîìèîñàðêîìà ïèùåâàðèòåëüíîãî òðàêòà. Äðóãîé
ôîðìîé ÑÌÒ, ðåçèñòåíòíîé ê ÕÒ, ñ÷èòàþò íåé-
ðîôèáðîñàðêîìó. Åñòü äàííûå, ÷òî ñèíîâèàëüíàÿ
ñàðêîìà ìîæåò áûòü îòíîñèòåëüíî áîëåå ÷óâñòâè-
òåëüíîé ê èôîñôàìèäó â âûñîêèõ äîçàõ. Â äâóõ
ðàçëè÷íûõ èññëåäîâàíèÿõ ýôôåêòèâíîñòü òàêîãî
ëå÷åíèÿ ñîñòàâèëà ïî÷òè 100% [36, 53].
Èçâåñòíî, ÷òî ðåçóëüòàòû ëå÷åíèÿ äåòåé ñ ÑÌÒ
ñóùåñòâåííî ëó÷øå. Àëüâåîëÿðíûå è ýìáðèîíàëüíûå
ðàáäîìèîñàðêîìû ÿâëÿþòñÿ íàèáîëåå ÷àñòî âûÿâëÿå-
ìûìè ôîðìàìè ÑÌÒ ó äåòåé. Äî íà÷àëà àêòèâíîãî
ïðèìåíåíèÿ ÕÒ îêîëî 80% áîëüíûõ ñ ðàáäîìèîñàð-
êîìîé ïîãèáàëè, íåñìîòðÿ íà àãðåññèâíîå ìåñòíîå
ëå÷åíèå (îïåðàöèÿ + îáëó÷åíèå).  íàñòîÿùåå âðåìÿ
îêîëî 70% òàêèõ ïàöèåíòîâ, â òîì ÷èñëå 20�30% ñ
ìåòàñòàòè÷åñêèì ïðîöåññîì ïîëíîñòüþ èçëå÷èâàþò-
ñÿ. Ëå÷åíèå âçðîñëûõ ñ ðàáäîìèîñàðêîìîé îñíîâàíî
íà òåõ æå ïðèíöèïàõ, êîòîðûå ñ óñïåõîì ïðèìåíÿ-
þòñÿ ïðè ëå÷åíèè äåòåé.  ÷àñòíîñòè, ðåêîìåíäóþò
ðåæèìû, ðàçðàáîòàííûå Intergroup Rhabdomyo-
sarcoma Study (IRS-III èëè IRS-IV) [86].
Ðîëü ÕÒ ïðè ÑÌÒ ïðîäîëæàþò àêòèâíî èçó-
÷àòü. Hàïðèìåð, íà 1 àïðåëÿ 2000 ã. â áàçå äàííûõ
Hàöèîíàëüíîãî èíñòèòóòà ðàêà ÑØÀ èìåëàñü
èíôîðìàöèÿ î 4 ðàíäîìèçèðîâàííûõ èññëåäîâà-
íèÿõ ïðè ÑÌÒ ó âçðîñëûõ [52]:
EORTC-62931 Àäúþâàíòíàÿ âûñîêîäîçîâàÿ
ÕÒ (äîêñîðóáèöèí/èôîñôàìèä) ïðè ÑÌÒ âûñî-
êîé ñòåïåíè çëîêà÷åñòâåííîñòè
EORTC-62933 Håîàäúþâàíòíàÿ âûñîêîäîçî-
âàÿ ÕÒ (äîêñîðóáèöèí/èôîñôàìèä ± G-CSF) è
óäàëåíèå ìåòàñòàçîâ â ëåãêèõ ïî ñðàâíåíèþ ñ òîëü-
êî óäàëåíèåì ìåòàñòàçîâ ÑÌÒ
EORTC-62971 Äâå ðàçëè÷íûå äîçû èôîñôà-
ìèäà ïðîòèâ äîêñîðóáèöèíà ïðè ðàñïðîñòðàíåí-
íûõ ôîðìàõ ÑÌÒ
EORTC-62961 Håîàäúþâàíòíàÿ ÕÒ (ýòîïî-
çèä/èôîñôàìèä/äîêñîðóáèöèí) â êîìáèíàöèè ñ
ìåñòíîé ãèïåðòåðìèåé ïî ñðàâíåíèþ ñ òîëüêî
íåîàäúþâàíòíîé ÕÒ ïðè ÑÌÒ âûñîêîé ñòåïåíè
çëîêà÷åñòâåííîñòè.
Òàêèì îáðàçîì, íàèáîëåå ýôôåêòèâíûìè öè-
òîñòàòèêàìè ÿâëÿþòñÿ äîêñîðóáèöèí è èôîñôà-
ìèä, ïðè÷åì óñòàíîâëåíà çàâèñèìîñòü ýôôåêòèâ-
íîñòè îáîèõ ïðåïàðàòîâ îò äîçû. Õèìèîòåðàïèþ
ïðèìåíÿþò êàê ýëåìåíò ðàäèêàëüíîãî êîìáèíè-
ðîâàííîãî ëå÷åíèÿ, à òàêæå êàê ïàëëèàòèâíûé
ìåòîä ïðè ìåòàñòàòè÷åñêîì ïðîöåññå. Ïðè ðàá-
äîìèîñàðêîìå õèìèîòåðàïèÿ ýôôåêòèâíà ïðàêòè-
÷åñêè ïðè ëþáîé ñòàäèè çàáîëåâàíèÿ.
ËÈÒÅÐÀÒÓÐÀ
1. Alvegard TA, Saeter G. The role of pulmonary
metastasectomy for soft tissue sarcoma. Acta Orthop Scand Suppl
1997; 273: 145�7.
Ê Î Ð Ï Î Ð À Ò È Â Í À ß È Í Ô Î Ð Ì À Ö È ß
ÎÍÊÎËÎÃÈß � Ò. 2 � ¹ 1�2 � 2000130
2. Alvegard TA, Sigurdsson H, Mouridsen H, et al. Adjuvant
chemotherapy with doxorubicin in high-grade soft tissue
sarcoma: a randomized trial of the Scandinavian Sarcoma Group.
J Clin Oncol 1989; 7: 1504�13.
3. Amodio A, Carpano S, Manfredi C, et al. Gemcitabine
in advanced stage soft tissue sarcoma: a phase II study. Clin Ter
1999; 150: 17�20.
4. Andrews N, Wilson W. Phase II study of methotrexate (NSC
740) in solid tumors. Cancer Chemother Rep 1967; 51: 471�4.
5. Antman K, Crowley J, Balcerzak SP, et al. An intergroup
phase III randomized study of doxorubicin and dacarbazine with
or without ifosfamide and mesna in advanced soft tissue and bone
sarcomas. J Clin Oncol 1993; 11: 1276�85.
6. Antman K, Ryan L, Borden E, et al. Pooled result from
three randomized adjuvant studies of doxorubicin versus
observation in soft tissue sarcoma: 10-year results. Proc Am Soc
Clin Oncol 1990; 9: A1204.
7. Antman KH, Montella D, Rosenbaum C, Schwen M.
Phase II trial of ifosfamide with mesna in previously treated
metastatic sarcoma. Cancer Treat Rep 1985; 69: 499�502.
8. Antman KH, Ryan L, Elias A, et al. Response to ifosfamide
and mesna: 124 previously treated patients with metastatic or
unresectable sarcoma. J Clin Oncol 1989; 7: 126�31.
9. Baker LH, Frank J, Fine G, et al. Combination
chemotherapy using Adriamycin, DTIC, cyclophosphamide,
and actinomycin D for advanced soft tissue sarcomas: A
randomized comparative trial. J Clin Onc 1987; 5: 851�61.
10. Balcerzak SP, Benedetti J, Weiss GR, Natale RB. A
phase II trial of paclitaxel in patients with advanced soft tissue
sarcomas. A Southwest Oncology Group study. Cancer 1995;
76: 2248�52.
11. Barista I, Tekuzman G, Yalcin S, et al. Treatment of
advanced soft tissue sarcomas with ifosfamide and doxorubicin
combination chemotherapy. J Surg Oncol 2000; 73: 12�6.
12. Benjamin RS, Legha SS, Patel SR, Nicaise C. Single-
agent ifosfamide studies in sarcomas of soft tissue and bone: the
M.D. Anderson experience. Cancer Chemother Pharmacol 1993;
31 (Suppl 2): 174�9.
13. Benjamin TO, Terjanian TO, Fenoglio CJ, et al. The
importance of combination chemotherapy for adjuvant treatment
of high-risk patients with soft-tissue sarcomas of the extremities.
In: Salmon SE, ed. Adjuvant therapy of cancer. Vol VI.
Philadelphia: WB Saunders, 1990: 735�44.
14. Blay J-Y, Glabbeke M van, Nielsen OS, et al. Five-
year survivors in patients with advanced soft tissue sarcoma treated
with doxorubicin: a study on 1742 patients (STBSG). Proc Am
Soc Clin Oncol 1998; 17: A1973.
15. Blay JY, Judson I, Rodenhuis S, et al. Phase II study of
raltitrexed («Tomudex») for patients with advanced soft tissue
sarcomas refractory to doxorubicin-containing regimens.
Anticancer Drugs 1999; 10: 873�7.
16. Blum RH. An overview of studies of Adriamycin (NSC-
123127) in the United States. Cancer Chemother Rep 1975; 6:
247�51.
17. Borden EC, Amato D, Enterline HT, et al. Randomized
comparison of Adriamycin regimens for treatment of metastatic
soft tissue sarcomas. J Clin Oncol 1987; 5: 840�50.
18. Borden EC, Amato DA, Edmonson JH, et al.
Randomized comparison of doxorubicin and vindesine to
doxorubicin for patients with metastatic soft-tissue sarcomas.
Cancer 1990; 66: 862�7.
19. Bramwell V, Mouridsen HT, Santoro A, et al.
Cyclophosphamide vs ifosfamide: Final report of a randomized
phase II trial in adult soft tissue sarcoma. Eur J Cancer Clin Oncol
1987; 23: 311�21.
20. Bramwell V, Rouesse J, Steward W, et al. Adjuvant
CYVADIC chemotherapy for adult soft tissue sarcoma �
reduced local recurrence but no improvement in survival: a study
of the European Organization for Research and Treatment of
Cancer Soft Tissue and Bone Sarcoma Group. J Clin Oncol 1994;
12: 1137�49.
21. Bramwell VH, Eisenhauer EA, Blackstein M, et al. Phase
II study of topotecan (NSC 609 699) in patients with recurrent or
metastatic soft tissue sarcoma. Ann Oncol 1995; 6: 847�9.
22. Budd GT, Metch B, Balcerzak SP, et al. High-dose cisplatin
for metastatic soft tissue sarcoma. Cancer 1990; 65: 866�9.
23. Buesa JM, Lopez-Pousa A, Martin J, et al. Phase II
trial of first-line high-dose ifosfamide in advanced soft tissue
sarcomas of the adult: a study of the Spanish Group for Research
on Sarcomas (GEIS). Ann Oncol 1998; 9: 871�6.
24. Buesa JM, Mouridsen HT, Oosterom ATV, et al. High-
dose DTIC in advanced soft-tissue sarcomas in the adult. A phase
II study of the EORTC soft tissue and bone sarcoma group. Ann
Oncol 1991; 2: 307�9.
25. Bui BN, Chevallier B, Chevreau C, et al. Efficacy of
lenograstim on hematologic tolerance to MAID chemotherapy
in patients with advanced soft tissue sarcoma and consequences
on treatment dose-intensity. J Clin Oncol 1995; 13: 2629�36.
26. Casper ES, Gaynor JJ, Hajdu SI, et al. A prospective
randomized trial of adjuvant chemotherapy with bolus versus
continuous infusion of doxorubicin in patients with high-grade
extremity soft tissue sarcoma and an analysis of prognostic factors.
Cancer 1991; 68: 1221�9.
27. Casper ES, Gaynor JJ, Harrison LB, et al. Preoperative
and postoperative adjuvant combination chemotherapy for adults
with high grade soft tissue sarcoma. Cancer 1994; 73: 1644�51.
28. Casper ES, Waltzman RJ, Schwartz GK, et al. Phase
II trial of paclitaxel in patients with soft-tissue sarcoma. Cancer
Invest 1998; 16: 442�6.
29. Chang AE, Kinsella T, Glatstein E, et al. Adjuvant
chemotherapy for patients with high-grade soft-tissue sarcomas
of the extremity. J Clin Oncol 1988; 6: 1491�500.
30. Chawla SP, Rosen G, Lowenbraun S, et al. Role of
high dose ifosfamide (HDI) in recurrent osteosarcoma. Proc Am
Soc Clin Oncol 1990; 9: A310.
31. Chevreau C, Bui BN, Chevallier B, et al. Phase I�II
trial of intensification of the MAID regimen with support of
lenograstim (rHuG-CSF) in patients with advanced soft-tissue
sarcoma. Am J Clin Oncol 1999; 22: 267�72.
32. Cruz AB Jr, Thames EA Jr, Aust JB, et al. Combination
chemotherapy for soft tissue sarcomas: A phase III study. J Surg
Oncol 1979; 11: 313�23.
33. Czownicki Z, Utracka-Hutka B. Clinical studies with
uromitexan-an antidote against urotoxicity of holoxan.
Preliminary results. Nowotwory (Pol) 1981; 30: 377�83.
34. Edmonson JH, Ebbert LP, Nascimento AG, et al. Phase
II study of docetaxel in advanced soft tissue sarcomas. Am J Clin
Oncol 1996; 19: 574�6.
35. Edmonson JH, Fleming TR, Ivins JC, et al. Randomized
study of systemic chemotherapy following complete excision of
nonosseous sarcomas. J Clin Oncol 1984; 2: 1390�6.
36. Edmonson JH, Ryan LM, Blum RH, et al. Randomized
comparison of doxorubicin alone versus ifosfamide plus
doxorubicin or mitomycin, doxorubicin, and cisplatin against
advanced soft tissue sarcomas. J Clin Oncol 1993; 11: 1269�75.
37. Eilber FR, Giuliano AE, Huth JF, Morton DL. A
randomized prospective trial using postoperative adjuvant
chemotherapy (adriamycin) in high-grade extremity soft-tissue
sarcoma. Am J Clin Oncol 1988; 11: 39�45.
38. Elias A, Ryan L, Sulkes A, et al. Response to mesna,
doxorubicin, ifosfamide, and dacarbazine in 108 patients with
metastatic or unresectable sarcoma and no prior chemotherapy.
J Clin Oncol 1989; 7: 1208�16.
39. Elias AD, Eder JP, Shea T, et al. High dose ifosfamide with
mesna uroprotection: A phase I study. J Clin Oncol 1990; 8: 170�8.
40. Fernberg JO, Wiklund T, Monge O, et al. Chemotherapy
in soft tissue sarcoma. The Scandinavian Sarcoma Group
experience. Acta Orthop Scand Suppl 1999; 285: 62�8.
ÎÍÊÎËÎÃÈß � Ò. 2 � ¹ 1�2 � 2000 131
Ê Î Ð Ï Î Ð À Ò È Â Í À ß È Í Ô Î Ð Ì À Ö È ß
41. Fetscher S, Brugger W, Bertz H, et al. High-dose
chemotherapy with autologous peripheral blood stem cell
transplantation for metastatic gastric leiomyosarcoma. Bone
Marrow Transplant 1997; 20: 787�8.
42. Frustaci S, Buonadonna A, Romanini A, et al. Increasing
dose of continuous infusion ifosfamide and fixed dose of bolus
epirubicin in soft tissue sarcomas. A study of the Italian group on
rare tumors. Tumori 1999; 85: 229�33.
43. Frustaci S, Gherlinzoni F, De Paoli A, et al.
Maintenance of Efficacy of adjuvant chemotherapy in soft tissue
sarcoma of the extremities up-date of a randomized trial. Proc
Am Soc Clin Oncol 1999; 18: A2108.
44. Gershenson DM, Kavanagh JJ, Copeland LJ, et al.
Cisplatin therapy for disseminated mixed mesodermal sarcoma
of the uterus. J Clin Oncol 1987; 5: 618�21.
45. Gherlinzoni F, Bacci G, Picci P, et al. A randomized trial
for the treatment of high-grade soft-tissue sarcomas of the extremities:
preliminary observations. J Clin Oncol 1986; 4: 552�8.
46. Glabbeke M van, Mouridsen H, Radford J, et al.
Response to anthracycline based chemotherapy and overall
survival in patients with lung metastases from soft tissue sarcoma:
a retrospective study of the Eortic Soft Tissue and Bone Sarcoma
Group (STBSG). Proc Am Soc Clin Oncol 1999; 18: A2093.
47. Glenn J, Kinsella T, Glatstein E, et al. A randomized,
prospective trial of adjuvant chemotherapy in adults with soft
tissue sarcomas of the head and neck, breast, and trunk. Cancer
1985; 55: 1206�14.
48. Glenn J, Sindelar WF, Kinsella T, et al. Results of
multimodality therapy of resectable soft-tissue sarcomas of the
retroperitoneum. Surgery 1985; 97: 316�5.
49. Goldstein D, Cheuvart B, Trump DL, et al. Phase II
trial of carboplatin in soft-tissue sarcoma. Am J Clin Oncol 1990;
13: 420�3.
50. Greenlee RT, Taylor M, Bolden S, Wingo PA. Cancer
statistic, 2000. Ca J Clin 2000; 50: 7�33.
51. Hoesel van QG, Verweij J, Catimel G, et al. Phase II
study with docetaxel (Taxotere) in advanced soft tissue sarcomas
of the adult. EORTC Soft Tissue and Bone Sarcoma Group.
Ann Oncol 1994; 5: 539�42.
52. http://cancernet.nci.nih.gov
53. Kampe CE, Rosen G, Eilber F, et al. Synovial sarcoma.
A study of intensive chemotherapy in 14 patients with localized
disease. Cancer 1993; 72: 2161�9.
54. Klein HO, Wickramanayake PD, Coerper CL, et al.
High-dose ifosfamide and mesna as continuous infusion over five
days-a phase I/II trial. Cancer Treat Rev 1983; 10 (Suppl A):
167�73.
55. Korbitzs BC, Davis HL Jr, Ramirez G, et al. Low doses
of vincristine (NSC-67574) for malignant disease. Cancer
Chemother Rep 1969; 53: 249�54.
56. Koscielniak E, Harms D, Henze G, et al. Results of
treatment for soft tissue sarcoma in childhood and adolescence:
a final report of the German Cooperative Soft Tissue Sarcoma
Study CWS-86. J Clin Oncol 1999; 17: 3706�19.
57. Le Cesne A, Antoine E, Spielmann M, et al. High-dose
ifosfamide: circumvention of resistance to standard-dose
ifosfamide in advanced soft tissue sarcomas. J Clin Oncol 1995;
13: 1600�8.
58. Lerner H, Amato D, Stevens C, et al. Leiomyosarcoma:
The Eastern Cooperative Oncology Group experience with 222
patients. Proc Am Assoc Cancer Res 1983; 24: A561.
59. Lerner HJ, Amato DA, Savlov ED, et al. Eastern
Cooperative Oncology Group: a comparison of adjuvant
doxorubicin and observation for patients with localized soft tissue
sarcoma. J Clin Oncol 1987; 5: 613�7.
60. Leyvraz S, Bacchi M, Cerny T, et al. Phase I multicenter
study of combined high-dose ifosfamide and doxorubicin in the
treatment of advanced sarcomas. Swiss Group for Clinical
Research (SAKK). Ann Oncol 1998; 9: 877�84.
61. Lopez M, Carpano S, Amodio A, et al. Single-agent
ifosfamide in the treatment of anthracycline-refractory adult
sarcomas. Clin Ter 1998; 149: 331�3.
62. Lopez-Pousa A, Buesa JM, Montalar J, et al. Phase II
trial of doxorubicin and high-dose ifosfamide in advanced
previously untreated soft tissue sarcoma patients. A study of the
Spanish Group for Research on Sarcomas (GEIS). Proc Am Soc
Clin Oncol 1999; 18: A2101.
63. Magrath I, Sandlund J, Raynor A, et al. A phase II
study of ifosfamide in the treatment of recurrent sarcomas in
young people. Cancer Chemother Pharmacol 1986; 18 (Suppl
2): 25�8.
64. Mansi JL, Fisher C, Wiltshaw E, et al. A phase I�II
study of ifosfamide in combination with Adriamycin in the
treatment of adult soft tissue sarcoma. Eur J Cancer Clin Oncol
1988; 24: 1439�43.
65. Meric F, Milas M, Hunt K, et al. Impact of neoadjuvant
chemotherapy on postoperative morbidity in sarcomas. Proc Am
Soc Clin Oncol 1999; 18: A2109.
66. Merimsky O, Meller I, Flusser G, et al. Gemcitabine in
soft tissue or bone sarcoma resistant to standard chemotherapy: a
phase II study. Cancer Chemother Pharmacol 2000; 45: 177�81.
67. Mouridsen HT, Bastholt L, Somers R, et al. Adriamycin
versus epirubicin in advanced soft tissue sarcomas. A randomized
phase II/phase III study of the EORTC Soft Tissue and Bone
Sarcoma Group. Eur J Cancer Clin Oncol 1987; 23: 1477�83.
68. Niederle N, Scheulen ME, Cremer M, et al. Ifosfamide
in combination chemotherapy for sarcomas and testicular
carcinomas. Cancer Treat Rev 1983; 10 (Suppl A): 129�35.
69. O�Bryan RM, Baker LH, Gottlieb JE, et al. Dose
response evaluation of Adriamycin in human neoplasia. Cancer
1977; 39: 1940�8.
70. O�Bryan RM, Luce JK, Talley RW, et al. Phase II evaluation
of Adriamycin in human neoplasia. Cancer 1973; 32: 1�8.
71. Omura GA, Major FJ, Blessing JA, et al. A randomized
clinical trial of adjuvant Adriamycin in uterine sarcomas: A
Gynecologic Oncology Group study. J Clin Oncol 1985; 3: 1240�5.
72. Oosterom van AT, Krzmienlecki K, Nielsen OS, et al.
Randomized Phase II study of the EORTC Soft Tissue and Bone
Sarcoma (STSBS) group comparing two different ifosfamide
regimens in chemotherapy untreated advanced soft tissue sarcoma
patients. Proc Am Soc Clin Oncol 1997; 16: A1787.
73. Palumbo R, Neumaier C, Cosso M, et al. Dose-intensive
first-line chemotherapy with epirubicin and continuous infusion
ifosfamide in adult patients with advanced soft tissue sarcomas: a
phase II study. Eur J Cancer 1999; 35: 66�72.
74. Palumbo R, Palmeri S, Antimi M, et al. Phase II study
of continuous-infusion high-dose ifosfamide in advanced and/
or metastatic pretreated soft tissue sarcomas. Ann Oncol 1997;
8: 1159�62.
75. Pezzi CM, Pollock RE. Preoperative chemotherapy for soft
tissue sarcoma of the extremities. Arm Surg 1990; 211: 476�481.
76. Pisters PW, Fein DA, Somlo G. Soft tissue sarcomas.
In Cancer Management: A Multidisciplinary Approach. Editors
R Pazdur, LR Coia, WJ Hoskins, LD Wagman. Huntington,
NY: PRR, 1997: 508�24.
77. Pisters PW, Patel SR, Harrison LB, et al. Preoperative
chemotherapy for stage IIIB extremity soft tissue sarcoma: long term
results from a single institution. J Clin Oncol 1997; 15: 3481�7.
78. Ravaud A, Bui NB, Coindre JM, et al. Adjuvant
chemotherapy with CYVADIC in high risk soft tissue sarcoma: A
randomized prospective trial. In: Salmon SE, ed. Adjuvant therapy
of cancer. Vol 6. Philadelphia: WB Saunders, 1990: 556�66.
79. Reichardt P, Tilgner J, Hohenberger P, Dorken B. Dose-
intensive chemotherapy with ifosfamide, epirubicin, and filgrastim
for adult patients with metastatic or locally advanced soft tissue
sarcoma: a phase II study. J Clin Oncol 1998; 16: 1438�43.
80. Rosenberg SA, Glatstein E, Chang AE. The role of
adjuvant chemotherapy in the treatment of soft tissue sarcomas:
Ê Î Ð Ï Î Ð À Ò È Â Í À ß È Í Ô Î Ð Ì À Ö È ß
ÎÍÊÎËÎÃÈß � Ò. 2 � ¹ 1�2 � 2000132
review of National Cancer Institute studies. Monogr Ser Eur Org
Res Treat Cancer 1986; 16: 201�13.
81. Santoro A, Tursz T, Mouridsen H, et al. Doxorubicin
versus CYVADIC versus doxorubicin plus ifosfamide in first-
line treatment of advanced soft tissue sarcomas: a randomized
study of the European Organization for Research and Treatment
of Cancer Soft Tissue and Bone Sarcoma Group. J Clin Oncol
1995; 13: 1537�45.
82. Sarcoma Meta-analysis Collaboration. Adjuvant
chemotherapy for localised resectable soft-tissue sarcoma of
adults: meta-analysis of individual data. Lancet 1997; 350 (9092):
1647�54.
83. Schoenfeld D, Rosenbaum C, Horton J, et al. A
comparison of Adriamycin versus vincristine and Adriamycin
and cyclophosphamide for advanced sarcoma. Cancer 1982; 50:
2757�62.
84. Schutte J, Mouridsen HT, Stewart W, et al. Ifosfamide
plus doxorubicin in previously untreated patients with advanced
soft tissue sarcoma. The EORTC soft tissue and bone sarcoma
group. Eur J Cancer 1990; 26: 558�61.
85. Selawry OS, Holland JF, Wolman IJ. Effect of
vincristine (NSC-67574) on malignant solid tumors in children.
Cancer Chemother Rep 1968; 52: 497�9.
86. Singer S, Rubin B, Fletcher CDM, et al.
Rhabdomyosarcoma in adults: size, location, and response to
chemotherapy predicts survival. Proc Am Soc Clin Oncol 1999;
18: A2106.
87. Steward WP, Verweij J, Somers R, et al. Doxorubicin
plus ifosfamide with rhGM-CSF in the treatment of advanced
adult soft-tissue sarcomas: preliminary results of a phase II study
from the EORTC Soft-Tissue and Bone Sarcoma Group. J
Cancer Res Clin Oncol 1991; 117 (Suppl 4): 193�7.
88. Stuart-Harris R, Harper PG, Kaye SB, Wiltshaw E.
High-dose ifosfamide by infusion with mesna in advanced soft
tissue sarcoma. Cancer Treat Rev 1983; 10 (Suppl A): 163�4.
89. Subramanian S, Wiltshaw E. Chemotherapy of
sarcoma � a comparison of three regimes. Lancet 1978; (1):
683�6.
90. Thigpen JT, Blessing JA, Wilbanks GD. Cisplatin as
second-line chemotherapy in the treatment of advanced or
recurrent leiomyosarcoma of the uterus. Am J Clin Oncol 1986;
9: 18�20.
91. Tierney JF, Mosseri V, Stewart LA, et al. Adjuvant
chemotherapy for soft-tissue sarcoma: review and meta-analysis
of the published results of randomised clinical trials. Br J Cancer
1995; 72: 469�75.
92. Tursz T, Verweij J, Judson I, et al. Is high-dose chemotherapy
of interest in advanced soft tissue sarcomas? An EORTC randomized
Phase III trial. Proc Am Soc Clin Oncol 1996; 15: A973.
93. Villanova G, Delord JP, Bonvalot S, et al. Phase II trial
of intensive induction chemotherapy (API-AI) in adult patients
with advanced soft tissue sarcoma. Proc Am Soc Clin Oncol 1998;
17: A1970.
94. Weh HJ, Zugel M, Wingberg D, et al. Chemotherapy
of metastatic soft tissue sarcoma with a combination of
Adriamycin and DTIC or Adriamycin and ifosfamide. Onkologie
1990; 13: 448�52.
95. Zalupski M, Metch B, Balcerzak S, et al. Phase III
comparison of doxorubicin and dacarbazine given by bolus versus
infusion in patients with soft-tissue sarcomas: A Southwest
Oncology Group study. J Nat Cancer Inst 1991; 83: 926�32.
96. Zalupski M, Ryan J, Hussein M, Baker L. Defining
the role of adjuvant chemotherapy for patients with soft tissue
sarcomas of the extremities. Adjuvant Therapy of Cancer VII.
Philadelphia, Lippincott.
CHEMOTHERAPY OF SOFT TISSUE
SARCOMAS IN ADULTS
Ya.V. Shparyk
Summary. Chemotherapy has an increasing role in the
therapy of soft tissue sarcomas. Meanwhile, chemotherapy
of these tumors is frequently considered in general without
taking into account the peculiar clinical features of various
subtypes. Doxorubicin and ifosfamide are the most active
drugs in the treatment of soft tissue sarcomas.
Chemotherapy could be used both for radical and for
palliative treatment. For rhabdomyosarcoma,
chemotherapy is effective in all the stages of such disease.
Key Words: chemotherapy, soft tissue sarcoma, adults.
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| id | nasplib_isofts_kiev_ua-123456789-32929 |
| institution | Digital Library of Periodicals of National Academy of Sciences of Ukraine |
| issn | 1562-1774,0204-3564 |
| language | Russian |
| last_indexed | 2025-12-07T17:56:14Z |
| publishDate | 2000 |
| publisher | Iнститут експериментальної патології, онкології і радіобіології ім. Р. Є. Кавецького |
| record_format | dspace |
| spelling | Шпарик, Я.В. 2012-05-26T10:55:40Z 2012-05-26T10:55:40Z 2000 Химиотерапия взрослых больных с саркомами мягких тканей / Я.В. Шпарик // Онкологія. — 2000. — Т. 2, № 1. — С. 126-132. — Бібліогр.: 96 назв. — рос. 1562-1774,0204-3564 https://nasplib.isofts.kiev.ua/handle/123456789/32929 В обзоре рассмотрены общие принципы цитостатического лечения взрослых больных с саркомами мягких тканей. Роль химиотерапии при этом заболевании на протяжении последних лет повышается. Hаиболее эффективными цитостатиками являются доксорубицин и ифосфамид, причем у обоих препаратов установлена зависимость эффективности от дозы. Химиотерапию применяют как элемент радикального комбинированного лечения, а также как паллиативный метод при метастатическом процессе. При рабдомиосаркоме химиотерапия эффективна практически при любой стадии заболевания. Chemotherapy has an increasing role in the therapy of soft tissue sarcomas. Meanwhile, chemotherapy of these tumors is frequently considered in general without taking into account the peculiar clinical features of various subtypes. Doxorubicin and ifosfamide are the most active drugs in the treatment of soft tissue sarcomas. Chemotherapy could be used both for radical and for palliative treatment. For rhabdomyosarcoma, chemotherapy is effective in all the stages of such disease. ru Iнститут експериментальної патології, онкології і радіобіології ім. Р. Є. Кавецького Онкологія Корпоративная информация Химиотерапия взрослых больных с саркомами мягких тканей Chemotherapy of soft tissue sarcomas in adult Article published earlier |
| spellingShingle | Химиотерапия взрослых больных с саркомами мягких тканей Шпарик, Я.В. Корпоративная информация |
| title | Химиотерапия взрослых больных с саркомами мягких тканей |
| title_alt | Chemotherapy of soft tissue sarcomas in adult |
| title_full | Химиотерапия взрослых больных с саркомами мягких тканей |
| title_fullStr | Химиотерапия взрослых больных с саркомами мягких тканей |
| title_full_unstemmed | Химиотерапия взрослых больных с саркомами мягких тканей |
| title_short | Химиотерапия взрослых больных с саркомами мягких тканей |
| title_sort | химиотерапия взрослых больных с саркомами мягких тканей |
| topic | Корпоративная информация |
| topic_facet | Корпоративная информация |
| url | https://nasplib.isofts.kiev.ua/handle/123456789/32929 |
| work_keys_str_mv | AT šparikâv himioterapiâvzroslyhbolʹnyhssarkomamimâgkihtkanei AT šparikâv chemotherapyofsofttissuesarcomasinadult |