Intraarterial chemotherapy for extremity osteosarcoma and MFH in adults.
The neoadjuvant treatment of osteosarcoma using intravenous agents has resulted in survival rates of 55% to 77% [3, 5, 6, 20, 22, 35]. We designed a neoadjuvant chemotherapy protocol using combined intraarterial and intravenous agents to treat high-grade osteosarcoma and malignant fibrous histiocytoma of bone in an attempt to improve survival. We report the results of treating 53 adults (age 18-77 years) diagnosed with nonmetastatic extremity osteosarcoma or malignant fibrous histiocytoma. Preoperative chemotherapy consisted of intravenous doxorubicin followed by intraarterial cisplatinum administered repetitively every 3 weeks for three to five cycles, depending on tumor response assessed by serial arteriography. Dose and duration of cisplatin were adjusted for tumor size. After resection, good responders (90% or greater necrosis) underwent treatment with the same agents and poor responders were treated with alternative agents for longer duration. Minimum followup was 24 months (mean, 111 months; range, 24-235 months). Estimated Kaplan-Meier survival at 10 years was 82% and event-free survival was 79%. Forty-one patients (77%) had a good histologic response and 92% (49 of 53) underwent limb-sparing procedures. Local recurrence occurred in two patients (4%). These results compared favorably with those reported in the current literature.


METHODS
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Hugate
Ronald R
RR
The Denver Clinic for Extremities at Risk, Presbyterian/St Luke's Medical Center, 1601 E. 19th Avenue, Suite 3250, Denver, CO 80218, USA. hugate@msn.com
Wilkins
Ross M
RM
Kelly
Cynthia M
CM
Madsen
Walt
W
Hinshaw
Ioana
I
Camozzi
Anne B
AB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D050280:Arm Bones; D001859:Bone Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002945:Cisplatin / Q000008:administration & dosage*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D051677:Histiocytoma, Malignant Fibrous / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D007867:Leg Bones; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012516:Osteosarcoma / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011859:Radiography
D000970:Antineoplastic Agents; D004317:Doxorubicin; D002945:Cisplatin