<p>Gain and loss from transcatheter intra-arterial limb infusion of cisplatin for extremity osteosarcoma: a retrospective study of 99 cases in the past six years</p>

Abstract

Purpose We intend to analyze the gain and loss from transcatheter intra-arterial (IA) limb infusion of cisplatin for extremity osteosarcoma in the past six years. Patients and methods Between December 2009 and August 2014, a total of 99 patients were analyzed for efficiency and followed up for long-term survival. Based on the different administration methods of cisplatin, we divided them into the following two cohorts: IA infusion of cisplatin (n=48) and intravenous (IV) infusion of cisplatin (n=51). Except for cisplatin, all the other drugs were given intravenously. Cisplatin was given intra-arterially with an infusion time of 3 hrs or 6 hrs using a pump, whereas historical controls received IV infusion of cisplatin within 60 mins. Tumor neovascularity (TNV) was analyzed before infusion, and subsequent arteriograms were compared with the baseline to determine percent changes. Definitive surgery with intended wide resection and postoperative pathological evaluation were performed in all these patients. Results No local or overall survival benefit was found in the patients preoperatively treated with IA infusion of cisplatin compared with IV infusion ( P= 0.336 and 0.173, respectively). Furthermore, serial arteriography was used to predict a good histologic response with an accuracy of 73.1% and a sensitivity of 100%. There were sporadic cases with the telangiectatic subtype, which did not respond very well to IV chemotherapy, but later, the tumor obviously shrank after IA infusion of cisplatin. Our study also showed that the rates of the complication of skin and muscle necrosis were not so low as reported. Conclusion We did not observe any survival advantage of chemotherapy using IA infusion in osteosarcoma of the extremities. Arteriography for TNV can be used to predict the tumor histologic response. Malposition of the catheter might severely increase the complication of skin or muscle necrosis.

Effect of Cisplatin Arterial Infusion (CAI) on Primary Nonmetastatic Pelvic Osteosarcoma: A Preliminary Study

“…Although systematic adverse events, including nausea, vomiting, anemia and an increase in creatinine/aminotransferase levels, shared similar incidence rates and severities with the study reported by Xie et al, local skin hyperpigmentation and pelvic soft tissue necrosis in muscle occurred after only 3 and 1 of 24 CAI events (12.5% and 4.2%, respectively), which is more favorable than the situation reported in the most reviewed studies concerning extremity osteosarcoma. (13,29,32) This nding could be explained by the shorter local drugretention time since the pelvis has a more su cient blood supply and drainage.…”

“…(25)(26)(27) As a modi ed approach to augment the potential of chemotherapy drugs, the AI technique combined with MSCs has been studied for years. (13,28,29) In the present study, we attempted to investigate the therapeutic effect of the CAI + MSC + S protocol in osteosarcoma treatment. The 5-year OS and EFS rates were 57.8% and 52.5%, respectively.…”

“…Notably, Ferrari et al and Xie et al investigated CDDP administration at similar doses to those in the present study but yielded signi cantly poorer survival outcomes. (13,32) This may be because 120 mg/m 2 CDDP was given intraarterially in 72 h in the rst study, which is too long to achieve a high enough blood concentration; patients with tumor metastases at the initial diagnosis were included in the second study so that the survival rate would be reduced. We used relatively high-dose CDDP administered over 3 to 6 h combined with 4 other drugs, including etoposide, and made individualized adjustments to the protocol for patients with high-risk factors.…”

“…Wilkins et al and Xie et al deployed CT arterial angiography, which yielded sensitivity and speci city over 90% and 50%, respectively. (13,31,35,36) Nevertheless, a repeated CT arterial angiography assessment is di cult to be accepted by patients because it requires multiple invasive operations and high expenditure. RECIST-1.1-based MRI remains one of the most commonly used approaches in tumor response evaluation.…”

“…(12) Several clinical trials reported that employing an arterial infusion technique to deliver CDDP, in combination with an IV systematic chemotherapy regimen or not, can elevate the local drug concentration to vefold that of IV administration and can produce better survival in the treatment of extremity osteosarcoma. (13)(14)(15) Therefore, the arterial infusion of CDDP might have potential in the treatment of pelvic osteosarcoma.…”