Am. Villa et al., PREOPERATIVE AND POSTOPERATIVE CHEMOTHERA PY FOR NONMETASTATIC OSTEOSARCOMA OF THE EXTREMITIES IN CHILDREN, Medicina Clinica, 107(5), 1996, pp. 161-164
BACKGROUND: A preoperative and postoperative chemotherapy regimen was
applied to nonmetastatic osteosarcoma of the extremities in patients u
nder 16 years of age to prevent the progress to metastatic disease and
reduce the volume of the primary tumor in order to assess a conservat
ive surgery. PATIENTS AND METHODS: A modified T-10 chemotherapy regime
n was used before surgery, including high dose methotrexate, vincristi
ne, bleomycin, cyclophosphamide and dactinomicine. After surgery patie
nts with a grade of tumor necrosis > 90% received the same regimen up
to 45 weeks of treatment. For the cases with necrosis < 90%, this regi
men was substituted by adriamycine and cisplatinum. Survival was studi
ed in relation with age, sex, tumor site, levels of alkaline phosphata
se and LDH, surgical treatment and tumor necrosis in the surgical spec
imen after preoperatory chemotherapy. Uni and multivariate analysis we
re performed. RESULTS: Twenty seven patients with ages ranging from 5
to 15 years (median 11 years) were treated. The most common site of pr
imary tumor was femur, followed by humerus and tibie. In 9 cases (33%)
tumor necrosis was > 90%. Consecutive surgery was performed in 20 pat
ients and 7 suffered amputation or desarticulation of the extremity. T
wenty patients remain alive and disease-free at a median follow-up of
84 months. The probability of disease-free survival at 50 months is 71
%. The only factor which influenced significantly the survival was the
grade of tumor necrosis. Survival was 100% for the 9 patients with ne
crosis > 90% and 53% for the 18 cases with necrosis > 90% (p = 0.022).
CONCLUSIONS: Preoperative and postoperative chemotherapy achieve dise
ase-free survival in more than two thirds of patients with nonmetastat
ic osteosarcoma of the extremities and allow a non mutilant surgical t
reatment in the mayority of them.