NEOADJUVANT CHEMOTHERAPY FOR OSTEOSARCOMA OF THE EXTREMITY IN PATIENTS IN THE 4TH AND 5TH DECADE OF LIFE

From January 1986 to March 1993, 29 patients aged between 40 and 60 ye ars with primary high grade osteosarcoma of the extremity were treated at Rizzoli Institute with neoadjuvant chemotherapy. Before surgery pa tients received cisplatin and adriamycin. Postoperatively, patients wi th a good histologic response received the same two drugs preoperative ly used, while in case of poor response ifosfamide and etoposide were added to cisplatin and adriamycin. Twenty-five patients (86%) were sur gically treated with a limb salvage, whereas 4 patients (14%) were amp utated. With a median follow-up of 8 years (5-12), the 8-year event-fr ee survival was 57% and the 8-year overall survival was 62%. No chemot herapy-related deaths were recorded and toxicity was manageable. These results are significantly better than those achieved in 24 patients o f the same age, treated at Rizzoli Institute between 1975 and 1985 onl y with surgery (87% of amputation and 17% of 8-year event-free and ove rall survival) and indicate an advantage for the use of neo-adjuvant c hemotherapy also in patients with high grade osteosarcoma of the extre mity older than 40 years.