Neoadjuvant and Adjuvant Chemotherapy in Osteosarcoma (The Experience of HORC in the Shariati Hospital)

Abstract

Background: Osteosarcoma is the most common bone sarcoma, and the third most common malignancy in children and adolescents. Before 1970, amputation was the sole treatment. Eighty percent of patients died from metastatic diseases, most commonly in the lungs. Over the past three decades, effective neoadjuvant (preoperative) and adjuvant (postoperative) chemotherapy protocols have improved the ability to perform limb salvage resections, disease free survival and overall survival rates.
Patients and Methods: The study was conducted on 28 patients (15 male and 13 female) whose diagnoses were confirmed by excisional biopsy without any proof of metastasis in clinical and radiological assessments from September 2001 to November 2002. All patients were treated with three-drug regimen consisting of Adriamycin, Ifosfamide and Cisplatin. The neoadjuvant chemotherapy was administered in three courses. The first course, Ifosfamide (2gr/IV) and Adriamycin (75mg/m², IV infusion) were given on the first day and Ifosfamide (1.5 gr/m² by continuous infusion) alone for 6 days. The second course consisted of Adriamycin (75mg/m², IV infusion) and Cisplatin (100mg/m², IV infusion) for one day. The third course was the same as the first. After surgery, all patients received adjuvant therapy similar to the neoadjuvant protocol mentioned above. Limb salvage was the most common surgical method. The treatment outcome particularly depended on the percentage of tumor necrosis. Overall and disease-free survival were also measured.
Results: According to the tumor necrosis percentage, the tumor response to chemotherapy was classified from good to poor response. In this study, 63.6% of patients showed good response and 36.4% indicated poor or no response to chemotherapy. The tumor necrosis percentage was significantly correlated with age≤ 20 years (P= 0.01), tumor size ≤84 cm³ (P= 0.03) and the site of tumors in femurs (P= 0.03). The average follow-up time was 132 days, ranging from 15 to 618 days. The first year survival rate was 100%, and the disease-free survival (DFS) was 70.8% for the same time period. Disease-free survival was significantly correlated with the chemotherapy response (P= 0.03), which was 100% in the good response group in the first year.
Conclusion: Although we had utilized bone grafts for substantially resected bones, local relapses were remarkably low (2 cases), so we suggest that this surgical method can be a proper alternative treatment for different types of expensive prosthesis in countries with low socioeconomic status.