title: High-dose chemotherapy in the treatment of relapsed osteosarcoma: an Italian sarcoma group study.
abstract: OBJECTIVE
  To study the feasibility and activity of two courses of high-dose chemotherapy (HDCT) in patients with osteosarcoma in metastatic relapse.
  
  
  METHODS
  Patients with high-grade osteosarcoma in metastatic relapse (multiple metastases or solitary metastasis at intervals of less than 30 months) were eligible for study. High-dose chemotherapy consisted of carboplatin and etoposide followed by stem-cell rescue. A second course was planned 4 to 6 weeks after the first. Surgery was performed before or after HDCT.
  
  
  RESULTS
  Thirty-two patients were enrolled onto the study. At the end of the treatment, 25 patients were in complete remission (CR), six were alive with disease progression, and one died of toxicity. At present, 14 patients are alive with a median survival time of 23 months from study entry: four are in first CR, three are in second CR, and one is in fourth CR. Six patients are alive with disease. Eighteen patients (56%) died: 17 of disease and one of toxicity. Transplantation-related mortality was 3.1%. The relapse or progression disease rate was 84.4%. The 3-year overall survival rate is 20% and the 3-year disease-free survival rate is 12%.
  
  
  CONCLUSIONS
  HDCT combined with surgery is feasible and can induce CR in a large portion of patients. Two points, however, need to be considered: only patients who are chemosensitive to induction treatment can obtain CR after HDCT, and the length of remission is short, because most patients relapse. Thus novel strategies are needed to maintain the remission status or to treat patients who do not respond to induction treatment.
authors.affiliation: Department of Pediatrics, University of Turin, Italy. fagioli@pediatria.unito.it
authors.forename: F
authors.initials: F
authors.lastname: Fagioli
authors.forename: M
authors.initials: M
authors.lastname: Aglietta
authors.forename: A
authors.initials: A
authors.lastname: Tienghi
authors.forename: S
authors.initials: S
authors.lastname: Ferrari
authors.forename: A
authors.initials: A
authors.lastname: Brach del Prever
authors.forename: E
authors.initials: E
authors.lastname: Vassallo
authors.forename: A
authors.initials: A
authors.lastname: Palmero
authors.forename: E
authors.initials: E
authors.lastname: Biasin
authors.forename: G
authors.initials: G
authors.lastname: Bacci
authors.forename: P
authors.initials: P
authors.lastname: Picci
authors.forename: E
authors.initials: E
authors.lastname: Madon
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D003520:Cyclophosphamide / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D012516:Osteosarcoma / Q000188:drug therapy* / Q000556:secondary; D012074:Remission Induction; D016019:Survival Analysis; D014182:Transplantation, Autologous
chemical_list: D016179:Granulocyte Colony-Stimulating Factor; D005047:Etoposide; D003520:Cyclophosphamide; D016190:Carboplatin