Radiographic and histological studies of sixteen massive retrieved human allografts were carried out after the allografts had been in situ for four to sixtyfive months. The studies demonstrated that union between the allograft and the host took place slowly at cortical-cortical junctions by the formation of an external callus derived from the cortex of the host, and it it was covered by a pannus of fibrovascular reparative tissue. Two allografts that had been removed because of rejection were surrounded by an envelope of chronic inflammatory tissue that prevented union, adherence of soft tissue, and internal repair. Internal repair was more advanced about sites of fracture and adjacent to recurrent tumors than in other portions of the graft. These findings suggest that large frozen allografts in humans are osteoconductive rather than osteoinductive. From 1975 to 1990, 156 massive preserved allografts were used at the University of Florida to reconstruct defects that had been created by limb-salvaging resection for the treatment of musculoskeletal tumors. This report presents the observations on sixteen specimens: thirteen that had been retrieved from these patients for various reasons and three that had been provided by other institutions. * No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject ofthis article. No funds were received in support of this study.
Twelve consecutive patients with osteosarcoma who were without evidence of metastases were treated with Adriamycin and cis-platinum in an adjuvant fashion. The primary lesion was in the distal femur in five patients, proximal tibia in three, and one each in the proximal femur, proximal humerus, sacrum, and a previously irradiated orbit. Surgery consisted of amputation in eight, limb-salvage procedures in two, and regional resections in the patients with orbital and sacral lesions. Postoperatively, Adriamycin at 30 mg/m2/d, for three days alternated every three weeks with cis-platinum, 100 mg/m2, once daily or 60 mg/m2/d, for two days i.v. drip forced i.v. fluid diuresis. Adriamycin was given to a total dose of 540 mg/m2. Ten of 12 patients remain continually disease-free with a median time on study of 23+ months (range 12+-41+ months). Local recurrences, without evidence of metastatic disease, occurred in the patient with the orbital lesion and the patient who underwent the regional resection for the lesion of the proximal humerus at 20 and 17 months from diagnosis, respectively. Nine patients are off all chemotherapy from 6+ to 33+ months (median 22+ months). Administration of cis-platinum was limited to eight courses because of renal and ototoxicity. Despite appreciable toxicity, this chemotherapeutic regimen appears to be a highly effective adjuvant in the management of primary nonmetastatic osteosarcoma.
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