CHEMOTHERAPY OF MALIGNANT FIBROUS HISTIOCYTOMA OF BONE

Background: Malignant fibrous histiocytoma of bone (MFHB) is a rare tu mour with a 3 year survival of 30%-40% when treated with surgery alone . A small number of patients have previously been treated with pre-ope rative chemotherapy and responses observed. The aim of the present stu dy was to further determine the response of MFHB to pre-operative chem otherapy. Patients and methods: A non-randomised study of 18 patients with MFHB. Twelve had localised disease and 6 had pulmonary metastases . In 14 patients pre-operative treatment consisted of methotrexate 8 g /m2 on day 1, ifosfamide 3 g/m2 and doxorubicin 60 mg/m2 on day 10. Th is regimen was given twice and twice post-operatively. A further 4 pat ients received cisplatin 100 mg/m2 on day 1 and doxorubicin 25 mg/m2 o n days 1, 2, 3. Three cycles were given pre- and post-operatively. Res ults: 15 patients had surgery after chemotherapy. Tumour necrosis was present in all resection specimens and ranged from 50%-100%. 7/15 had > 90% necrosis. Disease free survival is 82% for those patients with a greater than 2 year follow-up. Conclusion: This study confirms previo us reports that MFHB is a chemosensitive tumour. In view of its rarity collaborative trials are needed to establish the optimum drug treatme nt including drug selection dose and duration.