title: Neoadjuvant chemotherapy for osteosarcoma of the extremities in patients aged 41-60 years: outcome in 34 cases treated with adriamycin, cisplatinum and ifosfamide between 1984 and 1999.
abstract: BACKGROUND
  It is unclear whether adult patients with high-grade non-metastatic osteosarcoma of the extremities, treated with neoadjuvant chemotherapy according to protocols designed for adults, have a different outcome than younger patients treated with conventional protocols.
  
  
  METHODS
  From 1994 through 1999, we treated 34 patients with non-metastatic osteosarcoma of the extremities. These patients were aged mean 50 years (41-60), and received 4 cycles of multidrug chemotherapy (1 preoperatively and 3 postoperatively). Each cycle consisted of a combination of Cisplatin/Adriamycin, Ifosfamide/Cisplatinum and Ifosfamide/Adriamycin. 30 patients had limb salvage and 3 underwent amputation. During preoperative treatment, 1 died of toxicity. 16 patients had a good histological response to chemotherapy (> or = 90% tumor necrosis) and 17 had a poor response.
  
  
  CONCLUSIONS
  With a median follow-up of 8 (5-11) years, 19/33 patients remained continuously disease-free and 14 relapsed (10 with metastases, 3 with local recurrence and metastases, and 1 with local recurrence alone). After further treatments, 2/14 relapsed patients are alive and disease-free, 11 died of tumor, and 1 is alive with uncontrolled disease. 5-year event-free survival and overall survival were 56% and 70%, respectively. These results, which are similar to those of 296 patients under 40 years of age who were treated with conventional chemotherapy (5-year EFS 59% and 5-year OS 70%), indicate that neoadjuvant chemotherapy improves prognosis and also reduces amputations in patients aged over 40 with osteosarcoma of the extremities.
authors.affiliation: Section of Chemotherapy, Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy. gaetano.bacci@ior.it
authors.forename: Gaetano
authors.initials: G
authors.lastname: Bacci
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferrari
authors.forename: Mario
authors.initials: M
authors.lastname: Mercuri
authors.forename: Alessandra
authors.initials: A
authors.lastname: Longhi
authors.forename: Nicola
authors.initials: N
authors.lastname: Fabbri
authors.forename: Stefano
authors.initials: S
authors.lastname: Galletti
authors.forename: Cristiana
authors.initials: C
authors.lastname: Forni
authors.forename: Alba
authors.initials: A
authors.lastname: Balladelli
authors.forename: Massimo
authors.initials: M
authors.lastname: Serra
authors.forename: Piero
authors.initials: P
authors.lastname: Picci
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000401:mortality; D002945:Cisplatin / Q000627:therapeutic use*; D004317:Doxorubicin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use*; D007866:Leg / Q000601:surgery; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012516:Osteosarcoma / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; D018906:Antineoplastic Agents, Alkylating; D004317:Doxorubicin; D002945:Cisplatin; D007069:Ifosfamide