Limb-sparing in patients with non-metastatic high-grade osteosarcoma.
OBJECTIVE
To improve survival rates and functional outcome in patients with non-metastatic, high-grade osteosarcoma of the extremities, using the Scandinavian Sarcoma Group XIV neoadjuvant chemotherapy protocol.


METHODS
The analysis included 37 patients treated during the period 2000-2005. Age range was 8 to 65 year (median 23). Seven (7/37) patients were excluded from the study. The remaining 30 patients received 2 cycles of preoperative chemotherapy (high dose methotrexate, cisplatin and doxorubicin). Surgery was carried out in the 9th week. Twenty-seven (90%) patients had limb-salvage operation and in the remaining 3 amputation was performed. Based on the histopathological assessment of the removed tumor patients were classified in two groups (regarding good or poor response to chemotherapy). All 30 patients received 3 courses of postoperative chemotherapy with the same regimen. Patients with poor response received 3 more cycles of chemotherapy with high dose ifosfamide. Follow-up was 2-8 years (mean 52 months).


RESULTS
Histopathological assessment showed poor response to neoadjuvant chemotherapy in 57% of the patients but no significant difference in 3-year survival between the 2 groups was noted. Three-year survival of the patients with local recurrence was 40 vs. 88% of those without local recurrence (p=0.013). Three-year survival of the patients with distant metastases was 20 vs. 92% of those without distant metastases (p=0.0002). Three-year overall survival (OS) was 80% and disease-free survival (DFS) 60% for all 30 patients.


CONCLUSIONS
Neoadjuvant chemotherapy in patients with high-grade osteosarcoma of the extremities gives the opportunity for limb-sparing operation and at the same time improves survival rates.
Department for Musculoskeletal Tumors, University Clinic for Orthopaedic Surgery, Skopje, FYROMakedonia. milan_samardziski@yahoo.com
M
M
Samardziski
G
G
Zafiroski
C
C
Tolevska
B
B
Zafirova-Ivanovska
S
S
Kostadinova-Kunovska
M
M
Kalicanin-Markovska
D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D012516:Osteosarcoma / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D010865:Pilot Projects; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D004317:Doxorubicin; D002945:Cisplatin; D007069:Ifosfamide; D008727:Methotrexate