Preoperative
chemotherapy with intraarterial cis-diamminedichloroplatin-II (
CDP) and
mannitol diuresis was administered to the primary
tumor in 42 patients with
osteosarcoma. The dose was 150 mg/m2 and more than 90% of the infusions were administered during a 2-week period. On occasion this period was extended to 3 weeks because of temporary
renal insufficiency or logistical circumstances. Definitive surgical specimens were prepared by means of an arteriogram-directed plane of dissection with mapping and random sections. Histologically,
tumor destruction was evaluated in terms of
necrosis, inflammatory response, and fibrovascular regeneration. Quantification of the percent of
tumor necrosis was as follows: less than 40% (consistent with spontaneous
necrosis and/or no
chemotherapy effect); 40% to 60% (possible
chemotherapy effect); 60% to 90% (
chemotherapy effect--partial response); and 90% to 100% (complete response). Therapeutic efficacy also was correlated with the number of
CDP courses (one to three, four to five, and six to seven) and
tumor subtype. Significant
therapeutic effect (greater than 60% destruction) was observed with four or more
CDP courses (one of nine
tumors [one to three courses] versus 26 of 33
tumors [four to seven courses] [P = 0.01]). More than 60% of the
tumor destruction was observed in the following subtypes: osteoblastic (22 of 28), fibroblastic (three of six), and telangiectatic (two of five). These data demonstrate that four or more courses of intraarterial
CDP are required to achieve optimum effects and that osteoblastic
osteosarcoma is highly responsive.