Osteosarcoma of the limbs.Report of the EORTC-SIOP 03 trial 20781 investigating the value of adjuvant treatment with chemotherapy and/or prophylactic lung irradiation

Abstract

The European Organization for Research on Treatment of Cancer (EORTC) trial 20781, concerning osteosarcoma of the limbs is reported. After definitive treatment of the primary tumor with amputation or irradiation, adjuvant treatment was given, randomized into either 9 months of chemotherapy according to a modified Rosen schedule, or elective bilateral lung irradiation of 20 Gy, or 3 months of chemotherapy followed by lung irradiation. The 4-year disease-free survival and total survival were 24% and 43%, respectively, with no difference between the treatment arms. In the radiotherapy arms the lung metastases were more frequently suitable for surgical treatment. The survival of patients with either tibia localizations or higher age was somewhat better. Local recurrences occurred in 16% of patients, 50% of them with distant metastases. The trial was executed from 1978 to 1983; 205 patients were evaluable and eligible, and three toxic deaths occurred in the chemotherapy arms. Elective lung irradiation provided the same survival as the adjuvant chemotherapy given in that time.

Effectiveness of multi-drug regimen chemotherapy treatment in osteosarcoma patients: a network meta-analysis of randomized controlled trials

“…The full texts of the remaining 69 articles were assessed, and the following types of studies were removed: non-randomized design (19); comparisons of the same type of chemotherapeutic drug (12); duplications or secondary studies (9); non-controlled studies (2); no desired outcomes (2); and other sarcoma studies (2). Eventually, 23 articles assessing a total of 5742 patients were included in the present systematic review [22–44] (Fig. 1, Table 1).…”

“…Jasmin [42]1978France1976-EORTC2718 (9–28)13/14Osteosarcoma2 yearsGilchrist GS [43]1978USANANA32NANAOsteosarcoma753 daysJ.M.V. Burgers [44]1988Netherlands1978–1983EORTC-SIOP03 (20781)1401–3087/53Osteosarcoma5 years Abbreviations : CCG Children’s Cancer Group, COSS Cooperative Osteosarcoma Study Group, EOI the European Osteosarcoma Intergroup, EORTC European Organization for Research on Treatment of Cancer, EURAMOS-1 The European and American Osteosarcoma Study Group, MIOS the Multi-institutional Osteosarcoma Study, MSKCC Memorial Sloan-Kettering Cancer Center, SFOP Societe Francaise d’Oncologie Pediatrique, SSG the Scandinavian Sarcoma Group, NA not available a Mean ± standardization; median (minimum-maximum); minimum-maximum …”

Osteosarcoma in Pre-adolescent Patients

“…Most authors accept the importance of intensifying systemic chemotherapy in order to improve the survival of these patients, but small increases in chemotherapeutic intensity have always been coupled with additive side-effects, such as cardiotoxicity and nephrotoxicity. 9,15,16 The identification of individuals with a poor prognosis has considerable merit in terms of determining the intensity of chemotherapy, though the assessment of individual risk should be based on reliable prognostic factors. It is well known that age is a significant prognostic factor in some types of paediatric cancer, such as acute lymphocytic leukaemia and neuroblastoma; therefore, pre-adolescence could be a possible prognostic risk factor in osteosarcoma.…”

Radiation Therapy in Pediatric Oncology

“…Certainly, in the clinical setting, gross disease in osteosarcoma requires a higher radiation dose for local control than does Wilms' tumor (GAITAN-YANGUAS 1981;. BARRETT 1978;BREUR and VAN DER SCHUEREN 1978;ZAHARIA et al 1986;BURGERS et al 1988;French Bone Tumor Study Group 1988). Given the dose limitation in bilateral whole lung irradiation, it is therefore of interest to explore the use of radiation as an adjuvant agent intended to prevent pulmonary metastatic disease (i.e., to treat presumptive micrometastatic disease).…”

“…The oldest of these studies, that of LOUGHEED et al (1965), analyzed 15 Gy prophylactic irradiation of one lung in conjunction with dactinomycin. In conjunction with SlOP, EORTC (BURGERS et al 1988) conducted a follow-up study, randomizing 205 patients with localized osteosarcoma among three arms. Newton and co-workers (NEWTON 1972;NEWTON and BARRETT 1978) reported on 14 patients given initial local radiation with delayed amputation in conjunction with 19.5 Gy bilateral whole lung irradiation.…”