Increased survival, limb preservation, and prognostic factors for osteosarcoma

Article Abstract:

Osteosarcoma is a form of bone cancer, and is especially common in younger people. The primary form of treatment is surgical removal of the affected bone, which often requires amputation of the limb. However, it has been found that the addition of adjuvant chemotherapy to the surgical treatment not only improves survival, but in some cases may make it possible for more conservative surgery and preservation of a limb. A study was conducted to evaluate the effectiveness of chemotherapy and surgery in the treatment of osteosarcoma; the study also evaluated patient and treatment factors which correlated with improved survival. Ninety-two patients, ranging in age from four to 28 years, were treated with cisplatin delivered into an artery. Twenty-eight patients showed sufficiently great responses to the chemotherapy that they were given extra courses of chemotherapy in hopes of making more conservative surgery possible. A week after the third infusion of cisplatin, the cancer was surgically removed, and after surgery the patients were treated with intravenous cisplatin and doxorubicin. It was possible to evaluate 62 surgical specimens. Tumor destruction greater than 90 percent was observed in 16 of 40 patients who received three or fewer chemotherapeutic courses prior to surgery and in 17 of 20 patients who received four or more. Conservative surgery was possible in 68 percent of the patients who received four or more courses, in contrast with only 23 percent of the patients who received fewer preoperative courses of chemotherapy. Metastatic spread of cancer to the lungs was common, affecting 36 patients; two patients developed metastatic cancer in other bones. A total of 46 patients - exactly half -remain free of disease at follow-up periods ranging from 18 to 78 months after diagnosis. Male patients suffered greater likelihood of recurrence and also greater likelihood of death from osteosarcoma. The degree of tumor necrosis, or tissue destruction, achieved after the preoperative chemotherapy was also predictive of recurrence; patients with low necrosis were more likely to suffer recurrence. The appearance of the tumor under the microscope also predicted the likelihood of recurrence, and cancers which did not have the classic appearance of osteosarcoma were more likely to recur. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Surgery, Cancer, Adjuvant chemotherapy, Bone tumors

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Effect of intraarterial versus intravenous cisplatin in addition to systemic doxorubicin, high-dose methotrexate, and ifosfamide on histologic tumor response in osteosarcoma (Study COSS-86)

Article Abstract:

Local treatment of bone cancer produced survival rates on the order of 15 to 20 percent. Newer methods of aggressive chemotherapy have improved this outcome dramatically; rates of survival, free from metastasis, range from 60 to 70 percent. These rates are sufficiently good that it becomes important to consider the quality of life afforded by the treatment, which, in the case of bone cancer, usually refers to the preservation of a limb. There is some theoretical advantage to the use of an intraarterial injection for chemotherapy for bone cancer. If the cancer is in, for example, the leg, then an injection into the appropriate artery will carry the chemotherapeutic agent directly towards the tumor. On the other hand, an intravenous injection will carry the agent first to the heart, from which it will be spread equally throughout the body. The intraarterial injection may also have an advantage in that the venous return from the limb can be restricted by a tourniquet, thus giving tissue in the limb greater time to absorb the chemotherapeutic agent from the blood. However, while these conceptual notions may seem appealing, any true benefit must be demonstrated experimentally. While intraarterial injections have been reported to be effective, a previously published direct comparison of intraarterial and intravenous injection failed to demonstrate a beneficial effect for intraarterial injection. This study, however, involved several different drug regimens that were not directly comparable. In the current study patients were given high-dose methotrexate, doxorubicin, and ifosfamide intravenously; in addition, each patient also received cisplatin either intraarterially or intravenously. No significant differences in response were observed between the intravenous and the intraarterial groups, indicating that the intraarterial injection does not provide appreciable benefit in this aggressive chemotherapy scheme. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dosage and administration, Injections, Intra-arterial, Intra-arterial injections

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Pediatric osteosarcoma: successful retreatment of relapsed primary tumor and soft tissue recurrence with intraarterial cis-diamminedichloroplatin-II

Article Abstract:

Great improvements have occurred in the chemotherapeutic treatment of bone cancer. However, little is known about the efficacy of retreating patients who have relapsed after initial treatment. In many cancers, the initial chemotherapeutic regimen is unlikely to be effective for retreatment after a relapse. However, in using the drug cis-diamminedichloroplatin-II, or CDP, to treat six children with bone cancer, this was found not to be the case. All six patients were initially treated with CDP chemotherapy, and extirpation of the tumor was performed in two. Unfortunately, all six patients developed recurrent tumor after periods ranging from 12 to 38 months. The same course of CDP treatment was reinstated in all six patients; a complete response was seen in five of the six children. The single patient who did not respond was taken off the regimen due to an allergic response; this patient was treated surgically and remains alive and well. Two of the remaining patients have died from metastatic tumor spread to the lungs. The results indicate that CDP should be considered even in a relapsed patient if it was previously successful. (Consumer Summary produced by Reliance Medical Information, Inc.)

Antineoplastic agents, Platinum compounds

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