title: Unstratified chemotherapy for non-metastatic osteosarcoma of the extremities in children.
abstract: OBJECTIVE
  The superiority of changing postoperative chemotherapy of osteosarcoma based on histological response of the primary tumor over non-tailored chemotherapy has not been confirmed. This multicenter study evaluated the effectiveness of an intensive unstratified chemotherapy regimen in Taiwanese children with osteosarcoma.
  
  
  METHODS
  Fifty patients younger than 18 years of age with previously untreated non-metastatic osteosarcoma of the extremities were enrolled. Patients were treated with pre- and postoperative chemotherapy, and surgery. Definitive surgery was scheduled in week 7 and postoperative chemotherapy was uniform without stratification regardless of histologic response.
  
  
  RESULTS
  Chemotherapy toxicities were considerable, but manageable. Treatment delay and decreased dose-intensity were common. There was one treatment-related mortality. Forty three patients (86%) received limb salvage surgery and 14 patients (33%) had a good histologic response to preoperative chemotherapy. With a median follow-up of 47.1 months, the 7-year event-free and overall survival rates were 51.6% and 67.6%, respectively.
  
  
  CONCLUSIONS
  This was the first multicenter study on the treatment of osteosarcoma from Taiwan. The results suggest that a non-tailored regimen may serve as an alternative treatment strategy in the management of osteosarcoma, particularly when histologic assessment of the tumor response is not available.
authors.affiliation: Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Ming-Tsan
authors.initials: MT
authors.lastname: Lin
authors.forename: Kai-Hsin
authors.initials: KH
authors.lastname: Lin
authors.forename: Dong-Tsamn
authors.initials: DT
authors.lastname: Lin
authors.forename: Rong-Sen
authors.initials: RS
authors.lastname: Yang
authors.forename: Chen-Tu
authors.initials: CT
authors.lastname: Wu
authors.forename: Meng-Yao
authors.initials: MY
authors.lastname: Lu
authors.forename: Iou-Jih
authors.initials: IJ
authors.lastname: Hung
authors.forename: Chao-Ping
authors.initials: CP
authors.lastname: Yang
authors.forename: Tai-Tsung
authors.initials: TT
authors.lastname: Chang
authors.forename: San-Ging
authors.initials: SG
authors.lastname: Shu
authors.forename: Rong-Long
authors.initials: RL
authors.lastname: Chen
authors.forename: Tyh-Chen
authors.initials: TC
authors.lastname: Hsiao
authors.forename: Wan-Hui
authors.initials: WH
authors.lastname: Chang
authors.forename: Kuo-Sin
authors.initials: KS
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D015251:Epirubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005121:Extremities; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D012516:Osteosarcoma / Q000188:drug therapy*; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013624:Taiwan; D016896:Treatment Outcome
chemical_list: D015251:Epirubicin; D005047:Etoposide; D003520:Cyclophosphamide; D002945:Cisplatin; D008727:Methotrexate