METHOTREXATE OSTEOPATHY IN PATIENTS WITH OSTEOSARCOMA

PURPOSE: To determine the frequency of osteopathy in patients treated with high-dose, short-term, intravenous methotrexate for osteosarcoma and whether this complication varies with patient age and methotrexate dose. MATERIALS AND METHODS: Radiographs and available scintigrams of 87 patients with osteosarcoma who received high-dose methotrexate wer e reviewed retrospectively for severe osteopenia, dense zones of provi sional calcification, insufficiency fractures, and involvement of mult iple bones. At least three of these radiographic abnormalities were re quired for the diagnosis of osteopathy. Patients with bone metastases were excluded. RESULTS: Eight patients (cumulative dose, 60-144 g/m(2) ) exhibited adverse skeletal findings similar to those described in ch ildren with leukemia who received low-dose maintenance methotrexate. I mages showed severe osteopenia (n = 8), dense zones of provisional cal cification (n = 8), multiple bone involvement (n = 6), and insufficien cy fractures (n = 6). Most commonly affected sites were the distal tib ia (n = 7), distal radius and proximal humerus (n = 3), and calcaneus and pubic ramus (n = 2). The affected patients were significantly youn ger (mean age, 9.2 years; P < .001) than the 79 unaffected patients (m ean age, 14.9 years). CONCLUSION: Osteopathy occurs in approximately 9 70 of children who receive high-dose methotrexate for osteosarcoma and is substantially more likely to occur in younger patients. The compli cation rate was not directly dose dependent.