Abstract
Aim
To compare two consecutive treatment programs in metastatic osteosarcoma at presentation.
Methods
Between 1987 and 1999 treatment of stage IIIB osteosarcoma included induction chemotherapy (CHT) which consisted in 3-5 cycles of intra-arterial doxorubicin (DOX) 75 mg/m2 or cis-platin (CDDP) 120 mg/m2, surgery or definitive local radiation therapy (RT) for primary and adjuvant CHT with DOX, CDDP or HDMTX. Thirty nine patients were included in this protocol. Since 2000 a more intensive induction CHT protocol was adopted. It consisted in 4 cycles of DOX 90 mg/m2 +CDDP 120 mg/m2 (24 patients) or DOX 60 mg/m2 +CDDP 120 mg/m2+Ifosfamide (IFO) 6 g/m2 (7 patients). Adjuvant chemotherapy included DOX, CDDP, IFO or VP-16. Residual lung deposits were removed at the end of adjuvant treatment.
Results
In the old protocol surgical removal of primary after preoperative CHT was performed only in 24% of cases. There was only one limb-salvage procedure. Due to early disease progression 19 patients (51%) received induction CHT only. Ten patients (25%) received CHT and RT. In the last series the distribution according to treatment was as follows: CHT + surgery – 61% (limb-salvage procedures in 14 cases (74%)); CHT + RT – 23%; CHT only – 16%. Overall survival was 18±7% and 7 ±5% at 5 and 3 years respectively in the old protocol compared with 42±10% and 21±10% in the recent series, p=0.004. Median survival increased from 11 to 27 months.
Conclusions
More aggressive CHT and systematic removal of residual lung metastases significantly increased the rate of limb-salvage procedures and improved survival. Overall results in metastatic osteosarcoma at presentation remain unsatisfactory.
