Primary chemotherapy and delayed surgery (neoadjuvant chemotherapy) for osteosarcoma of the extremities

Article Abstract:

While amputation alone is often used to treat bone cancer in the limbs, without adjuvant chemotherapy, the survival rate is poor. Treated with surgery alone, the five-year survival rate for osteosarcoma in the limbs is generally less than 20 percent. In a review of 127 patients treated for osteosarcoma of the extremities, several trends became clear. The introduction of neoadjuvant therapy, in which the chemotherapy is administered prior to the primary surgical treatment, resulted in five-year survival rates of better than 50 percent. The subjects in the present review received cisplatin along with either a high dose or a moderate dose of methotrexate. The survival was related to the patient's response to chemotherapy, which could be directly determined by examining the bone after surgery. Patients showing good necrosis (area of dead tissue) of the tumor had a 67 percent disease-free survival at five years; 42 percent of patients with only a fair response remained disease-free at five years. For the patients with a poor response to the neoadjuvant chemotherapy, the disease-free probability was 10 percent at 45 months. The records also showed that higher doses of methotrexate were superior to moderate doses, yielding five-year survival rates of 58 and 42 percent, respectively. In roughly 70 percent of the cases, it is possible to perform surgery to save the limb, and patients undergoing limb-salvage surgery do no worse than those undergoing complete amputation. In addition, attempts to improve the outcome for patients who responded poorly to chemotherapy met with no success. Some patients whose tumors showed little necrosis were given doxorubicin and bleomycin, but their outcomes were comparable to other poor responders. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Cancer, Amputation, Adjuvant chemotherapy

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The Instituto Rizzoli experience with small cell osteosarcoma

Article Abstract:

Small cell osteosarcomas are a rare form of bone cancer and are histologically distinct. In a review of about 1,000 cases of bone cancer, and 300 cases of Ewing's sarcoma, a bone cancer which arises in marrow, 11 cases of small cell osteosarcoma were identified. Two patients were under 10 years of age and none were over 20. Complete records and follow-up were available in all cases, providing the opportunity for a survey of the features of this unusual subtype of bone cancer. In nine patients, the tumor developed in long bones; in one the osteosarcoma developed in the sacrum and in one the scapula. Although small cell osteosarcoma is histologically distinct, there is the possibility of error if needle biopsies or frozen sections are used for diagnosis. The periodic acid-Schiff (PAS) stain is probably not appropriate to distinguish the tumor from Ewing's; the reticulum stain, which was positive for 9 of 11 patients may be more accurate in this regard. The prognosis for small cell osteosarcoma is poor. Only two patients remain alive, though it should be pointed out that three patients refused any sort of treatment. Of the two living patients, one is currently under treatment and one is disease-free at 24 months (since diagnosis). Ironically, the patient who is disease-free at two years had a poor response to preoperative chemotherapy. Unlike some other forms of cancer, the response of small cell osteosarcoma to chemotherapy is not well correlated with prognosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies

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Effect of postoperative transfusions on survival in osteosarcoma treated by multimodal therapy

Article Abstract:

Numerous reports have indicated that many cancer patients who undergo blood transfusions have a worse outcome than those who do not. The effect is marked in colorectal cancer, and though less so in breast cancer and soft tissue sarcomas, it is still statistically significant. The records of 155 patients with bone cancer were examined to determine if a similar effect occurred in osteosarcoma. Of the 155 patients, 41 had transfusions. About 66 percent of the patients with transfusions died, in contrast with 47 percent of those who did not. When patients were matched for age, sex, tumor characteristics and other aspects, the role of the transfusion in determining the overall prognosis became even more significant. Although it is not clear why the transfusion has this effect, there is evidence, primarily from kidney patients, that transfusion has a depressive effect on the immune system. It is possible that in the patients with osteosarcoma, some suppression of the immune system permits the more rapid growth and spread of tumor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Physiological aspects, Prognosis, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation, Blood transfusion

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