From March 1983 to September 1986, 126 patients with localized high-grade osteosarcoma of the extremities were treated with neoadjuvant chemotherapy. Preoperative treatment consisted of two cycles of i.v. methotrexate (MTX; 7.5 g/m2 randomized vs. 750 mg/m2) and two cycles of i.a. cis-diammine dichloroplatinum (CDDP; 120–150 mg/m2). Conservative surgery was performed in 91 cases (72%). Postoperatively, until December 1983, the patients with a necrosis greater than 90% were treated with two cycles of MTX and CDDP at the same doses used preoperatively. Of the 15 patients treated in this arm, ten (67%) developed distant metastases. The remaining 111 patients were treated postoperatively with three cycles of MTX, CDDP, and adriamycin (ADM) if necrosis was greater than 60% and with five cycles of ADM plus bleomycin (BCD) if necrosis was lower than 60%. At a medium follow-up of 30 months, 68 patients have been continuously disease free (61%), three had a local recurrence (3%), and 43 had distant metastasis (39%). Analyzing the results in terms of the dose of MTX, the percentage of continuously disease-free patients is higher for those treated with 7.5 mg/m2 (70%) than for those treated with lower doses (52%). Regarding the grade of necrosis, 82% of the patients with a good response have been continuously disease-free compared with 47% for the patients with a fair response and 33% for patients with a response lower than 60%.
Neoadjuvant chemotherapy for osteosarcoma: results in 126 consecutive patients
CAPANNA, RODOLFO;
1989-01-01
Abstract
From March 1983 to September 1986, 126 patients with localized high-grade osteosarcoma of the extremities were treated with neoadjuvant chemotherapy. Preoperative treatment consisted of two cycles of i.v. methotrexate (MTX; 7.5 g/m2 randomized vs. 750 mg/m2) and two cycles of i.a. cis-diammine dichloroplatinum (CDDP; 120–150 mg/m2). Conservative surgery was performed in 91 cases (72%). Postoperatively, until December 1983, the patients with a necrosis greater than 90% were treated with two cycles of MTX and CDDP at the same doses used preoperatively. Of the 15 patients treated in this arm, ten (67%) developed distant metastases. The remaining 111 patients were treated postoperatively with three cycles of MTX, CDDP, and adriamycin (ADM) if necrosis was greater than 60% and with five cycles of ADM plus bleomycin (BCD) if necrosis was lower than 60%. At a medium follow-up of 30 months, 68 patients have been continuously disease free (61%), three had a local recurrence (3%), and 43 had distant metastasis (39%). Analyzing the results in terms of the dose of MTX, the percentage of continuously disease-free patients is higher for those treated with 7.5 mg/m2 (70%) than for those treated with lower doses (52%). Regarding the grade of necrosis, 82% of the patients with a good response have been continuously disease-free compared with 47% for the patients with a fair response and 33% for patients with a response lower than 60%.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
