title: Neoadjuvant chemotherapy for radioinduced osteosarcoma of the extremity: The Rizzoli experience in 20 cases.
abstract: OBJECTIVE
  Evaluate treatment and outcome of 20 patients with radioinduced osteosarcoma (RIO). Because of previous primary tumor treatment, RIO protocols were different from others we used for non-RIO.
  
  
  METHODS
  Between 1983 and 1998, we treated 20 RIO patients, ages 4-36 years (mean 16 years), with chemotherapy (two cycles before surgery, three postoperatively). The first preoperative cycle consisted of high-dose Methotrexate (HDMTX)/Cisplatinum (CDP)/Adriamycin (ADM) and the second of HDMTX/CDP/Ifosfamide (IFO). The three postoperative treatments were performed with cycles of MTX/CDP; IFO was used as single agent per cycle repeated three times.
  
  
  RESULTS
  Two patients received palliative treatment because their osteosarcoma remained unresectable after preoperative chemotherapy. The remaining 18 patients had surgery (7 amputations, 11 resections); histologic response to preoperative chemotherapy was good in 8 patients, poor in 10. At a mean follow-up of 11 years (range, 7-22 years), 9 patients remained continuously disease-free, 10 died from osteosarcoma and 1 died from a third neoplasm (myeloid acute leukemia). These results are not significantly different from those achieved in 754 patients with conventional osteosarcoma treated in the same period with protocols used for conventional treatment. However, this later group had an 18% 3-year event-free survival after treatment of relapse vs. 0% in the RIO group.
  
  
  CONCLUSIONS
  Treated with neoadjuvant chemotherapy RIO seem to have an outcome that is not significantly different from that of comparable patients with conventional primary high grade osteosarcoma (5-year event-free survival: 40% vs. 60%, p = NS; 5-year overall survival 40% vs. 67%, p < 0.01).
authors.affiliation: Sections of Chemotherapy, Istituti Ortopedici Rizzoli, Bologna, Italy. gaetano.bacci@ior.it
authors.forename: Gaetano
authors.initials: G
authors.lastname: Bacci
authors.forename: Alessandra
authors.initials: A
authors.lastname: Longhi
authors.forename: Cristiana
authors.initials: C
authors.lastname: Forni
authors.forename: Nicola
authors.initials: N
authors.lastname: Fabbri
authors.forename: Antonio
authors.initials: A
authors.lastname: Briccoli
authors.forename: Enza
authors.initials: E
authors.lastname: Barbieri
authors.forename: Mario
authors.initials: M
authors.lastname: Mercuri
authors.forename: Alba
authors.initials: A
authors.lastname: Balladelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferrari
authors.forename: Piero
authors.initials: P
authors.lastname: Picci
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D020360:Neoadjuvant Therapy; D009381:Neoplasms, Radiation-Induced / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D012516:Osteosarcoma / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies
chemical_list: D002945:Cisplatin; D007069:Ifosfamide; D008727:Methotrexate