Neoadjuvant chemotherapy for high grade osteosarcoma of the extremities: Long-term results for patients treated according to the Rizzoli IOR/OS-3b protocol

G. Bacci, S. Ferrari, A. Longhi, C. Forni, F. Bertoni, N. Fabbri, M. Zavatta, M. Versari

Research output: Contribution to journalArticle

Abstract

The results of the Rizzoli IOR/OS-3b neoadjuvant protocol for the treatment of osteosarcoma of the extremity are reported. Preoperative chemotherapy consisted of two cycles of high-dose methotrexate (HDMTX i.v.), followed by a combination of cisplatin (CDP i.a.)/doxorubicin (ADM i.v.). Postoperatively all patients, regardless of the histologic response, received 3 more cycles of MTX, CDP/ADM alternated with 3 cycles of ifosfamide. In the study performed between January and December 1992 43 patients were enrolled and limb salvage was performed in 39 of them (91%). The histologic response to chemotherapy was good (90% or more tumor necrosis) in 24 patients (56%) and poor (less than 90% tumor necrosis) in 19 (44%). With a minimum follow-up of 7 years, 23 pts (53%) remained continuously free of disease, 19 relapsed and one died due to unrelated cause. In spite of the high number of limb salvages performed, only 2 local recurrences were registered. The 7-year event-free survival and overall survival were, respectively, 53% and 68%. The hematopoietic and extrahematopoietic toxicity experienced by the patients during the entire treatment was relatively mild. These long-term results confirm that, with neoadjuvant chemotherapy, it is possible to cure more than 60% of patients with osteosarcoma of the extremities, avoiding amputation in most of them. These results, however, are no better than those achieved in our previous study IOR/OS-3a, in which only poor responder patients received ifosfamide during the postoperative treatment.

Original languageEnglish
Pages (from-to)93-99
Number of pages7
JournalJournal of Chemotherapy
Volume13
Issue number1
Publication statusPublished - 2001

Fingerprint

Osteosarcoma
Extremities
Drug Therapy
Cytidine Diphosphate
Ifosfamide
Limb Salvage
Necrosis
Neoadjuvant Therapy
Amputation
Methotrexate
Doxorubicin
Cisplatin
Disease-Free Survival
Neoplasms
Recurrence
Survival
Therapeutics

Keywords

  • Cisplatin
  • Doxorubicin
  • Ifosfamide
  • Methotrexate
  • Neoadjuvant chemotherapy
  • Osteosarcoma
  • Rizzoli protocol

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Microbiology (medical)

Cite this

Neoadjuvant chemotherapy for high grade osteosarcoma of the extremities : Long-term results for patients treated according to the Rizzoli IOR/OS-3b protocol. / Bacci, G.; Ferrari, S.; Longhi, A.; Forni, C.; Bertoni, F.; Fabbri, N.; Zavatta, M.; Versari, M.

In: Journal of Chemotherapy, Vol. 13, No. 1, 2001, p. 93-99.

Research output: Contribution to journalArticle

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abstract = "The results of the Rizzoli IOR/OS-3b neoadjuvant protocol for the treatment of osteosarcoma of the extremity are reported. Preoperative chemotherapy consisted of two cycles of high-dose methotrexate (HDMTX i.v.), followed by a combination of cisplatin (CDP i.a.)/doxorubicin (ADM i.v.). Postoperatively all patients, regardless of the histologic response, received 3 more cycles of MTX, CDP/ADM alternated with 3 cycles of ifosfamide. In the study performed between January and December 1992 43 patients were enrolled and limb salvage was performed in 39 of them (91{\%}). The histologic response to chemotherapy was good (90{\%} or more tumor necrosis) in 24 patients (56{\%}) and poor (less than 90{\%} tumor necrosis) in 19 (44{\%}). With a minimum follow-up of 7 years, 23 pts (53{\%}) remained continuously free of disease, 19 relapsed and one died due to unrelated cause. In spite of the high number of limb salvages performed, only 2 local recurrences were registered. The 7-year event-free survival and overall survival were, respectively, 53{\%} and 68{\%}. The hematopoietic and extrahematopoietic toxicity experienced by the patients during the entire treatment was relatively mild. These long-term results confirm that, with neoadjuvant chemotherapy, it is possible to cure more than 60{\%} of patients with osteosarcoma of the extremities, avoiding amputation in most of them. These results, however, are no better than those achieved in our previous study IOR/OS-3a, in which only poor responder patients received ifosfamide during the postoperative treatment.",
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