Primary chemotherapy and delayed surgery for nonmetastatic osteosarcoma of the extremities. Results in 164 patients preoperatively treated with high doses of methotrexate followed by cisplatin and doxorubicin

摘要: Background. Neoadjuvant chemotherapy is the most accepted treatment for localized osteosarcoma. This has led to a great improvement in limb-sparing surgery and disease-free survival. Patients with good response preoperative showed higher survival rate. Current studies examine possibility of patients whose limbs could be rescued poor necrosis reduction side effects related aggressive treatments. Methods. Between September 1986 December 1989, 164 entered second neoadjuvant study conducted at Rizzoli Institute, Bologna, Italy, non-metastatic osteosarcoma extremities. Preoperative consisted two cycles high-dose methotrexate intravenously (IV) followed by cisplatin intraarterially doxorubicin IV. After surgery, classified as responders (> 90% tumor necrosis) received three more these drugs, whereas (< had chemotherapy, which included ifosfamide etoposide addition other drugs. Results. Limb salvage was performed 83% cases. At an average follow-up 54 months (36–76), 109 (66%) were continuously disease-free, 2 died from cardiotoxicity, 52 experienced metastases 3 local recurrence. In patients, The 5-year actuarial rate 63%, no differences between responders. Excluding 20 who major protocol violations, projected continuous 71%. Conclusions. With it possible cure than 60% nonmetastatic extremities, avoiding amputation Ifosfamide seem effective did not respond chemotherapy.