The value of serial arteriography in osteosarcoma: delivery of chemotherapy, determination of therapy duration, and prediction of necrosis.
OBJECTIVE
To investigate the value of serial arteriography to assess tumor response, predict necrosis, and individualize the duration of a combined intravenous (IV) and intraarterial (IA) neoadjuvant chemotherapy protocol in patients with biopsy-proven high-grade osteosarcoma or malignant fibrohistiocytoma of bone.


METHODS
Between July 1987 and March 2003, 109 patients completed a chemotherapy protocol of neoadjuvant IV doxorubicin and IA cisplatin. Patients were eligible regardless of age, disease stage, or disease site. A minimum of three IA cycles followed by definitive surgery was required for inclusion in the final analysis. IA dose and duration were increased for tumors larger than 10 cm. Initial arteriograms were scored as indicating mild, moderate, or marked tumor neovascularity (TNV). Subsequent arteriograms were prospectively compared with the baseline image for percent change in TNV. Treatment continued until a maximum of five cycles were administered or one of three criteria were met: (i) at least 90% decrease in TNV, (ii) plateau of effect, or (iii) no response.


RESULTS
Of 408 IA procedures, 42 patients underwent three cycles, 53 underwent four, and 14 required five cycles of neoadjuvant therapy. There was a 2.5% minor complication rate. Eighty-six percent of patients exhibited at least 90% decrease in TNV and 82% exhibited good histologic response (> or =90% tumor necrosis). Serial arteriography predicted a good histologic response with an accuracy of 90% and a sensitivity of 97%.


CONCLUSIONS
Serial arteriography was highly sensitive and accurately predicted good responses. This individually modified, dose-intensified neoadjuvant protocol yielded an excellent histologic response rate with minimal complications. Future endeavors should involve a multiinstitutional study of this unique approach.
Cullen
John W
JW
Childhood Hematology Oncology Associates, Presbyterian/St. Luke's Medical Center, 1601 East 19th Avenue, Suite 3250, Denver, CO 80218, USA.
Jamroz
Brandt A
BA
Stevens
Sidney L
SL
Madsen
Walt
W
Hinshaw
Ioana
I
Wilkins
Ross M
RM
Cullen
Patsy
P
Camozzi
Anne B
AB
Fink
Kyle
K
Peck
Sandford D
SD
Kelly
Cynthia M
CM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000098:blood supply* / Q000188:drug therapy / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D051677:Histiocytoma, Malignant Fibrous / Q000098:blood supply / Q000188:drug therapy; D006801:Humans; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D020360:Neoadjuvant Therapy; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging; D012516:Osteosarcoma / Q000098:blood supply* / Q000188:drug therapy / Q000473:pathology
D004317:Doxorubicin; D002945:Cisplatin