Neoadjuvant chemotherapy for osteosarcoma

Abstract

OBJECTIVE: To summarize the experience in neoadjuvant chemotherapy for osteosarcoma. METHODS: Between July 1996 and December 2002 113 patients, 65 males and 48 females, aged 7 approximately 31, with osteosarcoma located in pelvis (n = 2), sacrum (n = 1), proximal femur (n = 6), shaft of femur (n = 4), distal femur (n = 49), proximal tibia (n = 37), shaft of tibia (n = 2), distal tibia (n = 1), fibula (n = 3), scapula (n = 1), clavicle (n = 1), or proximal humerus, (n = 7) without metastasis, 7 of which being at the Ennecking stage of IIA and 106 of which being at the stage of IIB, underwent 2 cycles of chemotherapy with high dose methotrexate (MTX) preoperatively and then operation. If poor response was observed after the first cycle of chemotherapy MTX was abandoned and operation was performed immediately. Twenty-two patients underwent reimplantation of devitalized tumor bone and 80 patients underwent prosthetic replacement. The protocol of cisplatin, ifosfamide, and paclitaxel was adopted after operation. At least 3 cycles of chemotherapy were given postoperatively for all patients. The patients were followed up for 20 approximately 66 months. RESULTS: Sixty patients showed excellent response to the preoperative chemotherapy, 35 showed good response, and 18 showed poor response. Relapse of tumor was found in 12 out of the 22 patients (55%) receiving reimplantation of devitalized tumor bone and in 5 out of the 60 patients (8.3%) receiving prosthetic replacement. The 5-year survival rate of the whole group was 71.93%. The lung metastasis rates were 18.3%, 37%, and 78% in the preoperative excellent response group, good response group, and poor response group respectively. CONCLUSION: The neoadjuvant chemotherapy protocol with the second-line drugs such as ifosfamide and paclitaxel used to the patients responding poorly to MTX is more effective than the older protocol. Local arterial chemotherapy is feasible.