Treatment of non-metastatic high-grade osteosarcoma (study of 30 cases treated with Scandinavian osteosarcoma protocol XIV and surgery).
The aim of this study is to improve 3-years survival rates and functional outcome in high-grade osteosarcoma patients treated with amputations and limb-sparing surgery, introducing Scandinavian Sarcoma Group chemotherapy protocol (SSG XVI).


METHODS
During the period 2000-2005, thirty seven patients with high-grade, non-metastatic osteosarcoma on the extremities were treated at the Clinic for Orthopaedic Surgery in Skopje. Mail patients were 21 (57%) and female were 16 (43%). Patients age varied from 8 to 63 years (mean 18 +/- 13). Seven patients (7/37) did not comply with including criteria and were excluded from the study. The rest 30 patients were introduced to two courses of pre-operative chemotherapy (high doses of Methotrexate, Cisplatin and Adriamycin). Surgical treatment was in 9-th week of the protocol. In 27/30 (90%) of the patients limb-sparing surgery was done, and in 3/30 (10%) amputations were performed. Histopathological assessment of the tumour after the neo-adjuvant chemotherapy divided the patients into group with bad and group with good response. All the patients had 3 more courses of chemotherapy after surgery (same as the preoperative). Patients with bad response were introduced to 3 more cycles of 5 days with high-dose of Ifosfamide. Follow-up was from 2 to 8 years, mean 51 months.


RESULTS
Histopathological assessment showed that 57% of the patients had bad response to neo-adjuvant chemotherapy, but there was no statistical significance in the survival time of the groups (p = 0.06). Three-years survival time was 40% of the patients with local recurrence in comparison with 80% of the patients with no local recurrence. Three-years survival time was 20% of the patients with distant metastases in comparison with 92% of the patients with no metastases. Overall survival time (OS) was 80%. After 3 years 60% of the patients were disease-free (DFS).


CONCLUSIONS
High-grade osteosarcoma of the extremities treated with modern chemotherapy protocols enables limb-sparing in the same time with improved survival time of the patients. Introducing high-dose Ifosfamide in treatment of patients with bad response after neo-adjuvant chemotherapy improves their functional results as well as the survival time. Key words: osteosarcoma, neo-adjuvant chemotherapy, limb-sparing.
Samardziski
Milan
M
Musculoskeletal Tumours Department, University Orthopaedic Surgery Clinic, Ss. Cyril and Methodius University, Skopje, R. Macedonia. milan_samardziski@yahoo.com
Zafiroski
G
G
Tolevska
C
C
Zafirova-Ivanovska
B
B
Kostadinova-Kunovska
S
S
Kalicanin-Markovska
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D002648:Child; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004317:Doxorubicin; D005121:Extremities; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012516:Osteosarcoma / Q000188:drug therapy* / Q000601:surgery*; D055815:Young Adult
D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate