Primary chemotherapy and delayed surgery for malignant fibrous histiocytoma of bone in the extremity.
Between March 1983 and September 1988, 22 patients with non-metastatic malignant fibrous histiocytoma MFH of bone of the extremities were treated with two regimens of neo-adjuvant chemotherapy successively activated. Preoperatively, the patients received moderate doses of methotrexate and cisplatinum-Regimen 1- or high dose methotrexate, cisplatinum and adriamycin-Regimen 2. Cisplatinum was delivered intraarteriously, the other drugs intravenously. Limb salvage surgery was performed in 20 patients, and 2 patients were amputated. The surgical margins were adequate (radical or wide) in 18 cases and inadequate (marginal) in 4. The histologic response to chemotherapy was good (90% or more tumor necrosis) in 8 patients. In both regimens postoperative chemotherapy was tailored according to the grade of necrosis determined by preoperative treatment on the primary tumor. At an average follow-up of 40 months (15-70), 15 patients (68%) remained continuously disease-free and 7 relapsed with metastases. No local recurrences were observed. Regimen 2 was slightly more effective than Regimen 1 in terms of good histologic response (5/10 vs 1/12) and continuous disease-free survival (8/10 vs 7/127). The results demonstrate that, as in osteosarcoma, in non-metastatic malignant fibrous histiocytoma of bone in the extremities a high percentage of patients can be cured with neoadjuvant chemotherapy and that in most of them limb sparing surgery is possible and safe.
Bacci
G
G
Centro di Chemioterapia Oncologica, Istituto Ortopedico Rizzoli, Bologna, Italy.
Avella
M
M
Picci
P
P
Dallari
D
D
Malaguti
C
C
Biagini
R
R
Ruggieri
P
P
Balladelli
A
A
Ferrari
S
S
Caldora
P
P
D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D005260:Female; D005266:Femoral Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018219:Histiocytoma, Benign Fibrous / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D006811:Humerus; D007223:Infant; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D013977:Tibia