Neoadjuvant chemotherapy for osteosarcoma of the extremities in patients aged 41-60 years: Outcome in 34 cases treated with Adriamycin, Cisplatinum and Ifosfamide between 1984 and 1999

Gaetano Bacci, Stefano Ferrari, Mario Mercuri, Alessandra Longhi, Nicola Fabbri, Stefano Galletti, Cristiana Forni, Alba Balladelli, Massimo Serra, Piero Picci

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Background: It is unclear whether adult patients with high-grade non-metastatic osteosarcoma of the extremities, treated with neoadjuvant chemotherapy according to protocols designed for adults, have a different outcome than younger patients treated with conventional protocols. Patients and methods: From 1994 through 1999, we treated 34 patients with non-metastatic osteosarcoma of the extremities. These patients were aged mean 50 years (41-60), and received 4 cycles of multidrug chemotherapy (1 preoperatively and 3 postoperatively). Each cycle consisted of a combination of Cisplatin/Adriamycin, Ifosfamide/Cisplatinum and Ifosfamide/Adriamycin. 30 patients had limb salvage and 3 underwent amputation. During preoperative treatment, 1 died of toxicity. 16 patients had a good histological response to chemotherapy (≥ 90% tumor necrosis) and 17 had a poor response. Results and interpretation: With a median follow-up of 8 (5-11) years, 19/33 patients remained continuously disease-free and 14 relapsed (10 with metastases, 3 with local recurrence and metastases, and 1 with local recurrence alone). After further treatments, 2/14 relapsed patients are alive and disease-free, 11 died of tumor, and 1 is alive with uncontrolled disease. 5-year eventfree survival and overall survival were 56% and 70%, respectively. These results, which are similar to those of 296 patients under 40 years of age who were treated with conventional chemotherapy (5-year EFS 59% and 5-year OS 70%), indicate that neoadjuvant chemotherapy improves prognosis and also reduces amputations in patients aged over 40 with osteosarcoma of the extremities. Copyright

Original languageEnglish
Pages (from-to)377-384
Number of pages8
JournalActa Orthopaedica
Issue number3
Publication statusPublished - Jun 1 2007


ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

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