Unstratified chemotherapy for non-metastatic osteosarcoma of the extremities in children.
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.
Lin
Ming-Tsan
MT
Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan.
Lin
Kai-Hsin
KH
Lin
Dong-Tsamn
DT
Yang
Rong-Sen
RS
Wu
Chen-Tu
CT
Lu
Meng-Yao
MY
Hung
Iou-Jih
IJ
Yang
Chao-Ping
CP
Chang
Tai-Tsung
TT
Shu
San-Ging
SG
Chen
Rong-Long
RL
Hsiao
Tyh-Chen
TC
Chang
Wan-Hui
WH
Lin
Kuo-Sin
KS
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
D015251:Epirubicin; D005047:Etoposide; D003520:Cyclophosphamide; D002945:Cisplatin; D008727:Methotrexate