title: Intraarterial Cisplatin and intravenous adriamycin in nonmetastatic osteosarcoma of the extremities: a single institution experience in Taiwan.
abstract: BACKGROUND
  For nonmetastatic osteosarcoma of the extremities, the optimal treatment now consists of multiagent neoadjuvant and adjuvant chemotherapy and limb-sparing surgical procedures. The degree of tumor necrosis after neoadjuvant chemotherapy is one of the most important prognostic indicators. Intraarterial cisplatin and intravenous adriamycin could achieve a good initial tumor response and convert the response to an ultimate cure.
  
  
  METHODS
  Between January 1989 and July 2004, 16 patients with nonmetastatic osteosarcoma of the extremities received intravenous adriamycin and intraarterial cisplatin monthly for 2-5 courses, based on achievement of a maximized angiographic response, followed by limb salvage surgery and then adjuvant intravenous chemotherapy with adriamycin and cisplatin. After resection, if patients had a good response (the extent of tumor necrosis was > or =90%), the same regimen was administered intravenously every three weeks for a total of six courses of chemotherapy. Poor responders (tumor necrosis <90%) were treated with a regimen of high-dose methotrexate with leucovorin rescue (HD-MTX) or ifosfamide, cisplatin, and etoposide (ICE).
  
  
  RESULTS
  Patients received an average of four cycles of neoadjuvant intraarterial chemotherapy. Sixteen patients underwent limb-preservation surgery and 12 had >90% tumor necrosis. With an average follow-up of 93.5 months, 8 patients were continuously disease -free, 6 died of disease and 2 had no evidence of disease 112 and 182 months respectively after relapse. The 5-year overall survival rate was 61%. No patient developed clinically detectable cardiac toxicity or ototoxicity after adriamycin and cisplatin administration. Febrile neutropenia occurred infrequently.
  
  
  CONCLUSIONS
  This study shows the effectiveness of treating nonmetastatic osteosarcoma of the extremities with intraarterial cisplatin and intravenous adriamycin infusion in Taiwan. However, the number of patients evaluated and treated in a single hospital was obviously too few to be considered statistically robust and this regimen deserves further testing in a multi-institutional fashion.
authors.affiliation: Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Tai-Jan
authors.initials: TJ
authors.lastname: Chiu
authors.forename: Jun-Wen
authors.initials: JW
authors.lastname: Wang
authors.forename: Yi-Ju
authors.initials: YJ
authors.lastname: Chen
authors.forename: Yeh
authors.initials: Y
authors.lastname: Tang
authors.forename: Cheng-Hua
authors.initials: CH
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000188:drug therapy*; D002945:Cisplatin / Q000008:administration & dosage*; D004317:Doxorubicin / Q000008:administration & dosage*; D005121:Extremities; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D008297:Male; D020360:Neoadjuvant Therapy; D012516:Osteosarcoma / Q000188:drug therapy*; D013624:Taiwan
chemical_list: D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D004317:Doxorubicin; D002945:Cisplatin