title: [Neoadjuvant chemotherapy for osteosarcoma].
abstract: OBJECTIVE
  To summarize the experience in neoadjuvant chemotherapy for osteosarcoma.
  
  
  METHODS
  Between July 1996 and December 2002 113 patients, 65 males and 48 females, aged 7 approximately 31, with osteosarcoma located in pelvis (n = 2), sacrum (n = 1), proximal femur (n = 6), shaft of femur (n = 4), distal femur (n = 49), proximal tibia (n = 37), shaft of tibia (n = 2), distal tibia (n = 1), fibula (n = 3), scapula (n = 1), clavicle (n = 1), or proximal humerus, (n = 7) without metastasis, 7 of which being at the Ennecking stage of IIA and 106 of which being at the stage of IIB, underwent 2 cycles of chemotherapy with high dose methotrexate (MTX) preoperatively and then operation. If poor response was observed after the first cycle of chemotherapy MTX was abandoned and operation was performed immediately. Twenty-two patients underwent reimplantation of devitalized tumor bone and 80 patients underwent prosthetic replacement. The protocol of cisplatin, ifosfamide, and paclitaxel was adopted after operation. At least 3 cycles of chemotherapy were given postoperatively for all patients. The patients were followed up for 20 approximately 66 months.
  
  
  RESULTS
  Sixty patients showed excellent response to the preoperative chemotherapy, 35 showed good response, and 18 showed poor response. Relapse of tumor was found in 12 out of the 22 patients (55%) receiving reimplantation of devitalized tumor bone and in 5 out of the 60 patients (8.3%) receiving prosthetic replacement. The 5-year survival rate of the whole group was 71.93%. The lung metastasis rates were 18.3%, 37%, and 78% in the preoperative excellent response group, good response group, and poor response group respectively.
  
  
  CONCLUSIONS
  The neoadjuvant chemotherapy protocol with the second-line drugs such as ifosfamide and paclitaxel used to the patients responding poorly to MTX is more effective than the older protocol. Local arterial chemotherapy is feasible.
authors.affiliation: Musculoskeletal Tumor Center, People's Hospital, Peking Universality, Beijing 100044, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
authors.forename: Rong-li
authors.initials: RL
authors.lastname: Yang
authors.forename: Xiao-dong
authors.initials: XD
authors.lastname: Tang
authors.forename: Shun
authors.initials: S
authors.lastname: Tang
authors.forename: Da-sen
authors.initials: DS
authors.lastname: Li
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D002648:Child; D002945:Cisplatin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005266:Femoral Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D020360:Neoadjuvant Therapy; D012516:Osteosarcoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies
chemical_list: D005047:Etoposide; D002945:Cisplatin; D007069:Ifosfamide