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《Journal of Applied Clinical Pediatrics》 2009-15
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Serum Concentration Monitoring and High-Dose Methotrexate Chemotherapy for Osteosarcoma in Children

TANG Hong,DU Shu-xu,SUN Li-ming(Department of Pediatrics,Beijing Shijitan Hospital,Beijing 100038,China)  
Objective To investigate the relationship between methotrexate (MTX) dosage and serum concentration,clinical efficacy,side effects for osteosarcoma in children.Methods Twenty male and 4 female children with osteosarcoma were studied.The age was from 7 to 16 years (median age was 9.5 year).After different dosages of MTX (8 g/m2 group,10 g/m2 group,and 12 g/m2 group)were injected 12 hours later,calcium formyltetrahydrofolate (CF) was used to rescue,2 pre-operative courses and 6 to 8 postoperative courses of chemotherapy were executed.Total 204 cases were studied,48 cases before operation and 156 cases after operation.At each time after the administration of high-dose(HD)MTX,venous blood was draw at 0,24 h,48 h and 72 h,respectively.After centrifugation,the supernatant was chosen,and MTX concentration was measured by a flurorescence polarization immunoassay.The toxicity and side effects of MTX were analyzed combined with clinical manifestations.Results The MTX serum concentration at 0 hours increased with the increasing doses of MTX,while the concentration at 24 and 48 h had no significant difference.It might be related with the body internal environment,hydration and alkalization,or rescue with CF.The toxicity of HD-MTX was relevant with the serum concentration at 24 and 48 h.When the serum drug concentrations of 24 h or 48 h were above the safety margin (24 hours serum MTX concentrations8.5 μmol/L;48 hours,serum MTX concentrations1.0 μmol/L),the toxicity and side effects of MTX increased significantly.The most common drug side effects were gastrointestinal symptoms and leucopenia.The oral mucosal lesions became worse in 12 g/m2 group.Conclusion The monitoring of HD-MTX plasma concentration provides an objective clinical basis for the individualized chemotherapy.
【CateGory Index】: R738.1
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