Osteosarcoma treatment requires consultation with a specialist

Non-metastatic osteosarcoma

Several studies have been done which prove the superiority of intra-arterial Cisplatin therapy for Osteosarcoma: Best record for ten-year Osteosarcoma survival  But other hospitals have been unable to reproduce the results:  Intra-arterial Cisplatin therapy benefit not confirmed  The advocates of  intra-arterial Cisplatin therapy state that these researchers have not used proper methods.  The survival record of the above study done at Presbyterian/St. Luke's Medical Center, Denver, Colorado should be kept in mind when you read the abstracts (and full studies) which do NOT corroborate the effectiveness intra-arterial Cisplatin therapy.  Keep in mind that other researchers have NOT confirmed the effectiveness of ifosfamide OR post surgical chemotherapy in the treatment of Osteosarcoma.  Ifosfamide NOT proven effective against Osteosarcoma and  Post operative chemotherapy NOT proven effective against Osteosarcoma  IMPORTANT: The five year survival percentages of these hospitals should be compared with those of the Presbyterian/St. Luke's Medical Center study and those from M.D. Anderson Cancer Center.

 

 

Metastatic osteosarcoma

http://www.osteosarcomasupport.org/metastatic osteosarcoma.htm

 

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Superior survival in treatment

of primary nonmetastatic pediatric Osteosarcoma of the extremity.

Wilkins RM, Cullen JW, Odom L, Jamroz BA, Cullen PM, Fink K, Peck SD, Stevens SL, Kelly CM, Camozzi AB.

Institute for Limb Preservation at Presbyterian/St. Luke's Medical Center, Denver, Colorado 80210, USA.

BACKGROUND: A protocol to treat Osteosarcoma of the extremity was developed at two local institutions.

METHODS: The study involved a dose-intensified neoadjuvant (pre-operative) protocol of intravenous doxorubicin and intra-arterial cisplatin administered repetitively until maximum angiographic response was noted.

Definitive surgery was delayed until > or =90% reduction in tumor neovascularity was documented.

Prospective assessment of serial arteriograms was highly accurate (94%) in predicting histological response and assisted in surgical planning.

After resection, if patients were determined to be good responders (> or =90% tumor necrosis), they underwent a 4-month postoperative course with the same agents.

Poor responders (<90% necrosis) were treated with alternative agents for 12 months from diagnosis.

Forty-seven assessable patients with primary, high-grade, nonmetastatic osteosarcoma of the extremity were included in this analysis.

The median age was 15 years (range, 7-21 years).

RESULTS: Patients underwent an average of four preoperative intra-arterial courses.

Forty-three patients underwent limb-preservation procedures, and 41 had >90% tumor necrosis.

With an average follow-up of 92 months (range, 20-178 months), 39 patients were continuously disease free, 3 died of disease, 1 died of other causes, and 4 have no evidence of disease 11 to 51 months after relapse (all pulmonary metastases).

There were no local recurrences.

Kaplan-Meier analysis demonstrated a 10-year overall survival of 92% and an event-free survival of 84%.

CONCLUSIONS: This study demonstrates excellent survival with a dose-intensified neoadjuvant protocol. Future endeavors should involve a multi-institutional randomized study comparing this approach with another multiagent intravenous neoadjuvant protocol.

 

Publication Types:

* Clinical Trial
* Multicenter Study


PMID: 12794015 [PubMed - indexed for MEDLINE]

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Pharmacokinetic data from a randomized trial comparing IA and IV cisplatin as preoperative treatment for osteogenic sarcoma demonstrated no difference in plasma AUC, renal platinum excretion, or tumor platinum content (Bielack SS, Erttmann R, Looft G. Purfusi C, Delling G, Winkler K, Landbeck G. Platinum disposition after intraarterial and intravenous infusion of cisplatin for osteosarcoma. Cancer Chemother Pharmacol 1989:24376-380.)

In addition, in a randomized trial of preoperative treatment that compared two courses of cisplatin, given either IA or IV, in combination with one course of doxorubicin and two doses each of high dose methotrexate and ifosfamide, no difference was found in response (Winklerk, Bielack S, Delling G, Salzer-Kuntschik M, Kotz R, Greenshaw C, Jurgens H, Ritter J, Kusineerz-glaz C, Erttmann R. Effect of intraarterial versus intravenous cisplatin in addition to systemic doxorubicin, high -dose methotrexate, and ifosofamide on histologic tumor response in osteosarcoma (study COSS-86.) Cancer 1990: 66: 1703-1710.)

The use of IA cisplatin in combination with IV chemotherapy in this setting remains unproven." (Also see "Three Pertinent Abstracts, 1998-2001, from MEDLINE.)
 

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Adjuvant therapy of osteosarcoma - A Phase II trial: Southwest

Oncology Group study 9139

Mark M. Zalupski, Cathryn Rankin, James R. Ryan, David R. Lucas, Jeffrey Muler, Keith S. Lanier, George Thomas Budd, J. Sybil Biermann, Frederick J. Meyers, Karen Antman

 

The addition of ifosfamide to the combination of doxorubicin and cisplatin did not appear toimprove outcomes in teenagers and adults with osteosarcoma, with a 5-year survival rate of 58%. New agents or approaches in the treatment of patients with osteosarcoma are needed.

 

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 Research Article

Adjuvant (post operative) chemotherapy

for osteosarcoma may not increase survival after neoadjuvant (preoperative) chemotherapy and surgical resection
Keith R. Berend, MD 1 *, Ricardo Pietrobon, MD 2, Joseph O. Moore, MD 3, Louis Dibernardo, MD 4, John M. Harrelson, MD 1, Sean P. Scully, MD, PhD 1
1Department of Surgery, Division of Orthopaedics, Duke University Medical Center, Durham, North Carolina
2Department of Surgery, Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, North Carolina
3Department of Medicine, Division of Medical Oncology and Transplantation, Duke University Medical Center, Durham, North Carolina
4Department of Pathology, Division of Surgical Pathology, Duke University Medical Center, Durham, North Carolina
email: Keith R. Berend (kberend@mindspring.com)

*Correspondence to Keith R. Berend, Duke University Medical Center, Division of Orthopaedics, Box 3000, Durham, North Carolina 27710. Fax No.: 919-681-7859.

Keywords
osteosarcoma; chemotherapy; survival

Abstract

Background and Objectives
Osteosarcoma is a primary malignancy of bone. Current therapy includes neoadjuvant chemotherapy, surgery, and postoperative (adjuvant) chemotherapy. Prolonged treatment with chemotherapeutic agents may place patients at increased risk for complications including secondary malignancy. The authors have had promising results with neoadjuvant therapy and surgery alone in the treatment of osteosarcoma. This study retrospectively examines neoadjuvant therapy and surgery alone for the treatment of primary osteosarcoma of bone with no evidence of distant metastases.

Methods
Fifty-four patients, with localized osteosarcoma of bone received neoadjuvant therapy followed by definitive surgical resection. Thirty-five patients received chemotherapy after surgery (adjuvant group) and nineteen patients were followed without postoperative chemotherapy (no adjuvant group).

Results
Tumor necrosis was predictive of survival. Kaplan-Meier analysis revealed the use of postoperative chemotherapy was not a predictor of improved outcome. Four patients in the adjuvant therapy group died of secondary malignancy compared with none of the no adjuvant therapy group. Patient age, sex, race, and tumor location were not predictive of survival.

Conclusions
The use of adjuvant (post operative) chemotherapy in the treatment of localized osteosarcoma of bone did not increase survival after neoadjuvant (pre operative) therapy and definitive surgical therapy. Instead, there was an increased incidence of secondary malignancy after its use. J. Surg. Oncol. 2001;78:162-170. © 2001 Wiley-Liss, Inc.


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