INTRAARTERIAL VERSUS INTRAVENOUS CISPLATINUM (IN ADDITION TO SYSTEMICADRIAMYCIN AND HIGH-DOSE METHOTREXATE) IN THE NEOADJUVANT TREATMENT OF OSTEOSARCOMA OF THE EXTREMITIES - RESULTS OF A RANDOMIZED STUDY

Intra-arterial (IA) and intravenous (IV) cisplatinum (CDP) were studie d in a multiagent regimen of neoadjuvant chemotherapy for osteosarcoma of the extremities. Preoperatively two cycles of high-dose methotrexa te (HDMTX) were administered, followed 5 days later by CDP and Adriamy cin (ADM). MTX and ADM were administered IV, and CDP was delivered IA or IV. Postoperatively, good responders received 3 more cycles of the same drugs, while poor responders had a longer chemotherapy including ifosfamide. The rate of good histological response to chemotherapy was significantly higher in patients treated intraarterially (78% vs 46%: P < .004), while no significant differences in terms of disease-free survival were observed between patients who received CDP IA and patien ts who received CDP IV (55% vs 51%). In the IA group, however, there w as only one local recurrence vs 5 in the TV group. The IA infusion of CDP is more active on the primary tumor than the IV infusion.