Chemotherapy for osteosarcoma without high-dose methotrexate: a 12-year follow-up on 53 patients.
BACKGROUND
The clinical relevance of polychemotherapy in osteosarcoma is undisputed and well proven. In this retrospective study we report the results of chemotherapy treatment without high-dose methotrexate (HDMTX) for osteosarcoma.


METHODS
Between 1986 and 1992, 53 patients with stage IIB extremity osteosarcoma received multimodal therapy (age: 6-36 years, median 17 years). All patients received neoadjuvant and adjuvant chemotherapy with adriamycin, cisplatin, cyclophosphamide, and vincristine without HDMTX. In 60.4%, tumor volume was < or =150 ml and in 39.6% >150 ml. Surgical modalities were distributed as follows: 71.7% of patients received limb-sparing surgery, 20.8% ablative surgery, and 7.5% rotationplasty. 35.8% of patients developed pulmonary metastases.


RESULTS
Overall survival (OAS) was 71.7% after 5 years and 67.2% after 10 years. Ten-year OAS was not observed with local recurrences; without local recurrence 10-year OAS was 74.2% (p = 0.002). Five-year OAS was 31.6% in patients who developed pulmonary metastases. Ten-year OAS was 71.1% and 61.1% when tumor volume was < or =150 ml and >150 ml, respectively (p = 0.445). Ten-year OAS was 73.5% in responders to preoperative chemotherapy; in poor responders 62.1% (p = 0.353). Event-free 10-year survival was 70.8% in responders and 48.3% in poor responders (p = 0.099).


CONCLUSIONS
Compared to treatment protocols including HDMTX similar survival rates were achieved.
Tunn
Per-Ulf
PU
Department of Surgery and Surgical Oncology, Campus Buch, Robert Rössle Hospital, elios Klinikum, Charité University Medicine Berlin, Germany. per-ulf.tunn@charite.de
Reichardt
Peter
P
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002648:Child; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015996:Survival Rate
D008727:Methotrexate