Neoadjuvant chemotherapy for osteosarcoma of the extremity: long-term results of the Rizzoli's 4th protocol

From January 1993 to March 1995. 162 patients with osteosarcoma of extremit ies were treated according to the IOR/OS-4 protocol. 133 patients had local ised disease, while 29 had metastases at diagnosis. These last patients wer e simultaneously operated upon for their primary and metastatic lesions. Ch emotherapy consisted preoperatively of two cycles of high dose methotrexate (HDMTX) and one cycle each of cisplatin (CDP)-doxorubicin (ADM), CDP/ifosf amide (IFO) and IFO/ADM. After surgery, patients were treated with the afor e mentioned drugs used as single agents. The mean follow-up of all patients was 6.5 years (5.5-8 years). Surgery was a limb salvage in 94% of cases, a nd the 5-year event-free survival (EFS) and overall survival (OS) rates wer e 56 and 71% for patients with localised disease, and 17 and 24% for patien ts with metastases at diagnosis. These results did not differ from those ac hieved in our previous study (IOR/OS-3) in which IFO was used only postoper atively in poor responders. (C) 2001 Elsevier Science Ltd. All rights reser ved.