Abstract
Purpose of this study was to share our experience with combined therapy of patients with osteosarcoma of long tubular bones.
We have analyzed 173 patients with osteosarcoma-99 males and 74 females. The mean age was 18,5 years. Anatomical location included: femur-89 (51,4%) pts, tibia-41 (23,7%) pts, humerus-35 (20,2%) pts, other long tubular bones-8 (4,7%) pts. The following surgical procedures were performed: prosthetic reconstruction of the knee joint-71 (41,1%) pts, prosthetic reconstruction of the shoulder joint-14 (8,1%) pts, interscapular-thoracic resection-16 (9,2%) pts, segmental resection of bones with applying of Ilizarov’s device-4 (2,3%), amputations and exarticulations-68 (39,5%) pts.
In all patients we have carried out combined therapy. In case of lower extremity tumour localisation at the first stage we have performed intra-arterial preoperative chemotherapy of DOX 90 mg/m2 as 72-hour, at the second stage surgery. The histological response was evaluated according to Huvos score. Adjuvant chemotherapy in good responders (grade III-IV) comprised the drugs used preoperatively, in poor histological responders (grade I–II) CAP scheme. In some patients ifosfamide and etoposide were added. In case of upper extremity tumour localisation induction chemotherapy consisted of 3 cycles of CAP scheme, surgical treatment and adjuvant chemotherapy with CAP scheme (3 courses) in good responders. In poor histological responders we have added ifosfamide and etoposide.
At localised forms of osteosarcoma 5-years survival rate was 52,1±1,4%. Functional results are good in most patients. Without extra support move about 80% patients. At local-spread forms survival at 5-years is worse- 48,1±1,2%.
In patients with metastatic disease we have not observed full remission. Achieved results testify that combined therapy (surgery and chemotherapy) is optimum at treatment of patients with osteosarcoma at present day and permits to attain full recovery and to improve life quality of patients.
Correspondence should be addressed to Professor Stefan Bielack, Olgahospital, Klinikum Stuttgart, Bismarkstrasse 8, D-70176 Stuttgart, Germany. Email: s.bielack@klinikum_stuttgart.de
