Superior survival in treatment of primary nonmetastatic pediatric osteosarcoma of the extremity
- PMID: 12794015
- DOI: 10.1245/aso.2003.03.061
Superior survival in treatment of primary nonmetastatic pediatric osteosarcoma of the extremity
Abstract
Background: A protocol to treat osteosarcoma of the extremity was developed at two local institutions.
Methods: The study involved a dose-intensified neoadjuvant protocol of intravenous doxorubicin and intra-arterial cisplatin administered repetitively until maximum angiographic response was noted. Definitive surgery was delayed until > or =90% reduction in tumor neovascularity was documented. Prospective assessment of serial arteriograms was highly accurate (94%) in predicting histological response and assisted in surgical planning. After resection, if patients were determined to be good responders (> or =90% tumor necrosis), they underwent a 4-month postoperative course with the same agents. Poor responders (<90% necrosis) were treated with alternative agents for 12 months from diagnosis. Forty-seven assessable patients with primary, high-grade, nonmetastatic osteosarcoma of the extremity were included in this analysis. The median age was 15 years (range, 7-21 years).
Results: Patients underwent an average of four preoperative intra-arterial courses. Forty-three patients underwent limb-preservation procedures, and 41 had >90% tumor necrosis. With an average follow-up of 92 months (range, 20-178 months), 39 patients were continuously disease free, 3 died of disease, 1 died of other causes, and 4 have no evidence of disease 11 to 51 months after relapse (all pulmonary metastases). There were no local recurrences. Kaplan-Meier analysis demonstrated a 10-year overall survival of 92% and an event-free survival of 84%.
Conclusions: This study demonstrates excellent survival with a dose-intensified neoadjuvant protocol. Future endeavors should involve a multi-institutional randomized study comparing this approach with another multiagent intravenous neoadjuvant protocol.
Comment in
-
Intra-arterial cisplatin in osteosarcoma: same question, different answer.Ann Surg Oncol. 2003 Jun;10(5):481-3. doi: 10.1245/aso.2003.04.903. Ann Surg Oncol. 2003. PMID: 12794009 No abstract available.
Similar articles
-
Primary chemotherapy and delayed surgery for nonmetastatic osteosarcoma of the extremities. Results in 164 patients preoperatively treated with high doses of methotrexate followed by cisplatin and doxorubicin.Cancer. 1993 Dec 1;72(11):3227-38. doi: 10.1002/1097-0142(19931201)72:11<3227::aid-cncr2820721116>3.0.co;2-c. Cancer. 1993. PMID: 8242546
-
Improved survival in primary nonmetastatic pediatric osteosarcoma of the extremity.Clin Orthop Relat Res. 2005 Sep;438:128-36. doi: 10.1097/01.blo.0000179736.10871.76. Clin Orthop Relat Res. 2005. PMID: 16131881 Clinical Trial.
-
The value of serial arteriography in osteosarcoma: delivery of chemotherapy, determination of therapy duration, and prediction of necrosis.J Vasc Interv Radiol. 2005 Aug;16(8):1107-19. doi: 10.1097/01.RVI.0000167856.31329.F8. J Vasc Interv Radiol. 2005. PMID: 16105923
-
Pediatric osteosarcoma: treatment of the primary tumor with intraarterial cis-diamminedichloroplatinum-II (CDP)--advantages, disadvantages, and controversial issues.Cancer Treat Res. 1993;62:75-84. doi: 10.1007/978-1-4615-3518-8_11. Cancer Treat Res. 1993. PMID: 8096762 Review.
-
Intra-arterial chemotherapy for limb preservation in patients with osteosarcoma: nursing implications.Clin J Oncol Nurs. 2006 Oct;10(5):581-9. doi: 10.1188/06.CJON.581-589. Clin J Oncol Nurs. 2006. PMID: 17063612 Review.
Cited by
-
Niclosamide and Pyrvinium Are Both Potential Therapeutics for Osteosarcoma, Inhibiting Wnt-Axin2-Snail Cascade.Cancers (Basel). 2021 Sep 15;13(18):4630. doi: 10.3390/cancers13184630. Cancers (Basel). 2021. PMID: 34572856 Free PMC article.
-
Effect of Cisplatin Arterial Infusion (CAI) on Primary Nonmetastatic Pelvic Osteosarcoma: A Preliminary Study.Cancer Manag Res. 2021 Feb 15;13:1491-1503. doi: 10.2147/CMAR.S294677. eCollection 2021. Cancer Manag Res. 2021. PMID: 33623429 Free PMC article.
-
Definitive surgery of primary lesion should be prioritized over preoperative chemotherapy to treat high-grade osteosarcoma in patients aged 41-65 years.J Orthop Traumatol. 2020 Aug 31;21(1):13. doi: 10.1186/s10195-020-00552-w. J Orthop Traumatol. 2020. PMID: 32865641 Free PMC article.
-
Dihydrotanshinone I inhibits the growth of osteosarcoma through the Wnt/β-catenin signaling pathway.Onco Targets Ther. 2019 Jul 2;12:5111-5122. doi: 10.2147/OTT.S204574. eCollection 2019. Onco Targets Ther. 2019. Retraction in: Onco Targets Ther. 2023 Apr 12;16:275-276. doi: 10.2147/OTT.S416680. PMID: 31308689 Free PMC article. Retracted.
-
MicroRNA-542-3p suppresses tumor cell proliferation via targeting Smad2 inhuman osteosarcoma.Oncol Lett. 2018 May;15(5):6895-6902. doi: 10.3892/ol.2018.8238. Epub 2018 Mar 12. Oncol Lett. 2018. PMID: 29731864 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical
