Abstract
OBJECTIVE: To evaluate the efficacy and safety of thalidomide combined with ifosfamide (IFO) in the treatment of pulmonary metastatic osteosarcoma and to compare its outcomes with the IFO plus etoposide (ETOP) regimen, providing a reference for the clinical treatment of osteosarcoma. METHODS: In this retrospective study, clinical data from 95 patients with pathologically confirmed osteosarcoma were analyzed. Of these, 55 patients received thalidomide + IFO (Observation group), and 40 patients received IFO + ETOP (Control group). Progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and adverse reactions (ARs) were compared between the two groups. RESULTS: After treatment, the maximum diameters of both primary tumors and lung metastatic (LM) lesions in the Observation group were significantly smaller than those in the Control group. The median PFS was 10 months in the Observation group and 7.5 months in the Control group; the median OS was 22 months in the Observation group and 14 months in the Control group. The ORR and DCR in the Observation group were 23.63% and 52.73%, both significantly higher than those in the Control group (P<0.05). The incidences of hematological toxicity, gastrointestinal reactions, and renal dysfunction were significantly lower in the Observation group than in the Control group (P<0.05). Multivariate Cox regression analysis identified number of pulmonary metastases (HR=1.256, P=0.038), T stage (HR=1.453, P=0.033), N stage (HR=1.389, P=0.035), receipt of radiotherapy (HR=1.589, P=0.018), and LDH levels (HR=1.356, P=0.015) as independent prognostic factors for pulmonary metastatic osteosarcoma. CONCLUSION: Thalidomide + IFO notably improves PFS and OS in patients with pulmonary metastatic osteosarcoma, demonstrating superior safety compared with the IFO-ETOP regimen.