PREOPERATIVE AND POSTOPERATIVE CHEMOTHERA PY FOR NONMETASTATIC OSTEOSARCOMA OF THE EXTREMITIES IN CHILDREN

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.