Activity of intraarterial carboplatin as a single agent in the treatment of newly diagnosed extremity osteosarcoma

Background. Chemotherapy has dramatically improved the rates of cure and su rvival of patients with localized and metastatic osteosarcoma. Nonetheless, the number of chemotherapeutic agents active against osteosarcoma is limit ed to doxorubicin, cisplatin, high-dose methotrexate, and ifosfamide. Carbo platin, a cisplatin analogue, has been tested as a single agent in patients with recurrent osteosarcoma or as part of multiagent chemotherapy in newly diagnosed patients. Procedure. We tested the activity and toxicity of two cycles of intraarterial carboplatin as a "window therapy" (600 mg/m(2) per cycle) in 33 consecutive patients with extremity osteosarcoma before the st art of multiagent chemotherapy. Response was based on clinical (tumor diame ter, local inflammatory signs, and range of motion) and radiological parame ters (plain local films and arteriographic studies prior to drug administra tion). Results. Patients' age ranged between 8 and 18 years (median age 13 years). Primarytumor originated from the femur (15 patients), tibia (10 pat ients), fibula (4 patients), humerus (3 patients), and calcaneus (1 patient ). Only 7 patients (21%) had metastatic disease at diagnosis (5 in the lung and 2 in other bones). A favorable clinical and radiological response was documented in 81% and 73% of the patients, respectively. Clinical and radio logical progression occurred in 120% and 9% of the patients, respectively. Seventeen of the patients remain alive and disease-free. Survival and event -free survival at 3 years for nonmetastatic patients are 71% (SE = 9%) and 65% (SE = 9%), respectively; for metastatic patients, the figures are 17% ( SE = 15%) and 14% (SE = 13%), respectively. Conclusions. We conclude that c arboplatin is an active agent in the treatment of newly diagnosed extremity osteosarcoma. (C) 1999 Wiley-Liss, Inc.