title: Long-term results after combined modality treatment for non-metastatic osteosarcoma.
abstract: Since the introduction of multimodality treatment, the prognosis of patients with high-grade non-metastatic osteosarcoma has significantly improved. A retrospective review was performed to assess the long-term results of this approach in a single centre setting, and to investigate the impact of potential clinical prognostic factors. Between 1985 and 1993, 35 patients with stage II-A and II-B osteosarcoma underwent preoperative chemotherapy (high-dose methotrexate), wide surgery, and adjuvant chemotherapy (cisplatin-doxorubicin/bleo-mycin-cyclophosphamide-dactinomycin) (modified T-10A protocol). There were 19 males and 16 females. Median patient age was 17 y (range 12-42). Primary tumour sites were the extremities (83%) and axial bones (17%). In spite of an unfavourable grade 3-4 histologic response rate to high-dose methotrexate of 12%, 31 (88%) patients were able to undergo limb-sparing surgery and 28 (80%) were rendered disease free after the planned therapy. Median follow-up was 8 y. The actuarial overall survival and disease-free survival rates were 64% and 49% at 5 y, and 59% and 49% at 10 y, respectively. Tumour size and primary site were significant prognostic factors for survival in univariate analyses. In conclusion, long-term survival after combined modality treatment can be achieved in more than 60% of patients with localised osteosarcoma, including non-appendicular lesions. Limb-sparing surgery is a realistic goal for most cases. The prognostic value of tumour necrosis and the efficacy of neoadjuvant chemotherapy should be interpreted according to individual high-dose methotrexate scheduling.
authors.affiliation: Department of Medical Oncology, Hospital Universitario La Fe, Valencia, Spain. japaricio@ene.es
authors.forename: J
authors.initials: J
authors.lastname: Aparicio
authors.forename: A
authors.initials: A
authors.lastname: Segura
authors.forename: J
authors.initials: J
authors.lastname: Montalar
authors.forename: S
authors.initials: S
authors.lastname: Garcerá
authors.forename: A
authors.initials: A
authors.lastname: Oltra
authors.forename: A
authors.initials: A
authors.lastname: Santaballa
authors.forename: A
authors.initials: A
authors.lastname: Yuste
authors.forename: M
authors.initials: M
authors.lastname: Pastor
authors.forename: B
authors.initials: B
authors.lastname: Munárriz
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D002648:Child; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D008727:Methotrexate