Chemotherapy for Osteosarcoma without High-Dose Methotrexate: A 12-Year Follow-Up on 53 Patients

Abstract

The clinical relevance of polychemotherapy in osteosarcoma is undisputed and well proven. In this retrospective study we report the results of chemotherapy treatment without high-dose methotrexate (HDMTX) for osteosarcoma. Patients and Methods: Between 1986 and 1992, 53 patients with stage IIB extremity osteosarcoma received multimodal therapy (age: 6-36 years, median 17 years). All patients received neoadjuvant and adjuvant chemotherapy with adriamycin, cisplatin, cyclophosphamide, and vincristine without HDMTX. In 60.4%, tumor volume was =150 ml and in 39.6% >150 ml. Surgical modalities were distributed as follows: 71.7% of patients received limb-sparing surgery, 20.8% ablative surgery, and 7.5% rotationplasty. 35.8% of patients developed pulmonary metastases. Results: Overall survival (OAS) was 71.7% after 5 years and 67.2% after 10 years. Ten-year OAS was not observed with local recurrences; without local recurrence 10-year OAS was 74.2% (p = 0.002). Five-year OAS was 31.6% in patients who developed pulmonary metastases. Ten-year OAS was 71.1% and 61.1% when tumor volume was =150 ml and >150 ml, respectively (p = 0.445). Ten-year OAS was 73.5% in responders to preoperative chemotherapy; in poor responders 62.1% (p = 0.353). Event-free 10-year survival was 70.8% in responders and 48.3% in poor responders (p = 0.099). Conclusion: Compared to treatment protocols including HDMTX similar survival rates were achieved.

Prognostic Significance of αV Integrin and VEGF in Osteosarcoma after Chemotherapy

“…Surgery remains the vital modality for treating the primary tumor, whereas adjuvant chemotherapy plays an essential role in the control of subclinical metastatic disease. Although adjuvant chemotherapy has led to dramatic prognostic improvements, relapse and metastasis still represent major obstacles to the successful treatment of osteosarcoma [1,2]. During the metastatic process, tumor cells must arrest at the vessel wall, penetrate the endothelium and basal membrane, and migrate invasively toward their target tissue [3].…”

Spinal Osteosarcoma

“…The importance of doxorubin in doses of 390–450 mg/m 2 has been highlighted. 76–78 High dose methotrexate appears to be an unnecessary hardship but more studies are needed 79. In a recent meta-analysis study to determine the most effective chemotherapy regimen for localized high-grade osteosarcoma, protocols of 3 active substances were found to be the answer.…”

Chemotherapy for Osteosarcoma without High-Dose Methotrexate: Another Piece in the Puzzle

“…The report by P.R. Tunn and P. Reichardt in the current issue of ONKOLOGIE [13] adds novel information to this debate. These authors report here on a retrospective analysis of a nonOsteosarcoma is a rare tumor which remains a major model in multidisciplinary oncology, bringing together pediatrician and adult oncologists, orthopedic surgeons, and pathologists, all requested for the optimal care of the patients [1].…”