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A comparison of methods of loco-regional chemotherapy combined with systemic chemotherapy as neo-adjuvant treatment of osteosarcoma of the extremity.

AbstractAIM:
Our experience of pre-operative intraarterial (i.a.) vs intravenous (i.v.) infusion of cisplatinum (CDP) in a multiagent neo-adjuvant chemotherapy for osteosarcoma of the extremity is reported.
METHODS:
Two successive randomized studies were performed. In the first, pre-operatively, CDP i.a. vs CDP i.v. was applied in combination with high-dose methotrexate (HDMTX) and adriamycin (ADM) within a three-drug regimen. In the second, a combination of HDMTX, ADM and IFO, within a four-drug regimen was tested.
RESULTS:
The rate of responses to chemotherapy (tumour necrosis > or = 90%) was significantly higher (P<0.04) for the 142 patients treated with the four-drug regimen than in the 79 patients treated with a three-drug regimen (76%vs 62%). According to the route of CDP infusion, in the three-drug regimen the rate of responses was significantly higher (P=0.004) in patients treated with i.a. CDP (77%) than in patients treated i.v. (46%); with the four-drug regimen the rate of response was not significantly different in patients treated i.a. (81%) and in patients treated i.v. (71%). No significant differences in the rates of limb salvages, local recurrence and event-free survival (EFS) were seen between the i.a. and the i.v. groups.
CONCLUSION:
In the treatment of osteosarcoma of the extremity, the i.a. infusion of CDP does not offer any significant advantage when this drug is used within an aggressive, multiagent, pre-operative four-drug regimen.
AuthorsG Bacci, S Ferrari, A Tienghi, F Bertoni, M Mercuri, A Longhi, G Fiorentini, C Forni, P Bacchini, S Rimondini, U De Giorgi, P Picci
JournalEuropean journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Eur J Surg Oncol) Vol. 27 Issue 1 Pg. 98-104 (Feb 2001) ISSN: 0748-7983 [Print] England
PMID11237499 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)
CopyrightCopyright Harcourt Publishers Limited.
Chemical References
  • Doxorubicin
  • Cisplatin
  • Ifosfamide
  • Methotrexate
Topics
  • Adolescent
  • Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects)
  • Bone Neoplasms (drug therapy, mortality, surgery)
  • Chemotherapy, Adjuvant
  • Cisplatin (administration & dosage, adverse effects)
  • Combined Modality Therapy
  • Disease-Free Survival
  • Doxorubicin (administration & dosage)
  • Extremities
  • Female
  • Humans
  • Ifosfamide (administration & dosage)
  • Infusions, Intra-Arterial
  • Infusions, Intravenous
  • Male
  • Methotrexate (administration & dosage)
  • Neoplasm Recurrence, Local
  • Osteosarcoma (drug therapy, mortality, surgery)
  • Survival Rate

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