Assessing the Percent of Necrosis after Neoadjuvant Chemotherapy with 24hr Infusional Cisplatin/3 Days Doxorubicin Intermittent with IfosfamideDoxorubicin for Osteosarcoma
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Abstract
Introduction: Osteosarcoma is the most common primary bone tumor in children and young adults and appropriate chemotherapy can increase limb sparing and overall survival. Yet, the toxicity of chemotherapy regimens including MTX can be life threatening. Therefore; we tried another chemotherapy regimen for these patients.
Method and materials: We investigated 15 patients aged 15 to 40 years old and used continuous infusion of cisplatin, doxorubicin intermittently with ifosfamide, doxorubicin as neoadjuvant chemotherapy. Percent of necrosis and toxicities was recorded for each patient.
Results: Out of 15 patients investigated, 13 were males and 2 females. Tumor necrosis≥ 90% (defined as good necrosis) was observed in 60% of patients. 26.7% of the patients showed leucopenia grade three or four, 26.7% had anemia grade three or four, and 20% showed thrombocytopenia grade three or four.
Conclusion: The above chemotherapy regimen can cause as good necrosis as the chemotherapy regimens including high dose of MTX with reduced toxicity and less nursing cares and laboratory tests. Of course small sample size limits extension of our result to all patients but trying this regimen is recommended in more patients to see more reliable results.
Data from the American Cancer Society file://www.cancer.org/docroot/home/index.asp (Accessed on June 01, 2011).
Smith MA, Gurney JG, Ries LA. Cancer in adolescents 15 to 19 years old. In: Cancer Incidence and Survival Among Children and Adolescents: United States SEER Program 1975-1995 (Pub #99-4649), Ries LA, Smith MAS, Gurney JG, et al (Eds), SEER program, National Cancer Institute, Bethesda, MD 1999.
Anninga JK, Gelderblom H, Fiocco M, et al. Chemotherapeutic adjuvant treatment for osteosarcoma: where do we stand? Eur J Cancer 2011; 47:2431.
Rosen G. Preoperative (neoadjuvant) chemotherapy for osteogenic sarcoma: a ten year experience. Orthopedics 1985; 8:659.
Goorin AM, Schwartzentruber DJ, Devidas M, et al. Presurgical chemotherapy compared with immediate surgery and adjuvant chemotherapy for nonmetastatic osteosarcoma: Pediatric Oncology Group Study POG-8651. J Clin Oncol 2003; 21:1574.
Eilber F, Giuliano A, Eckardt J, et al. Adjuvant chemotherapy for osteosarcoma: a randomized prospective trial. J Clin Oncol 1987; 5:21.
Link MP, Goorin AM, Miser AW, et al. The effect of adjuvant chemotherapy on relapse-free survival in patients with osteosarcoma of the extremity. N Engl J Med 1986; 314:1600.
Link MP, Goorin AM, Horowitz M, et al. Adjuvant chemotherapy of high-grade osteosarcoma of the extremity. Updated results of the Multi-Institutional Osteosarcoma Study. Clin Orthop Relat Res 1991; :8
Bacci G, Ferrari S, Bertoni F, et al. Long-term outcome for patients with nonmetastatic osteosarcoma of the extremity treated at the istituto ortopedico rizzoli according to the istituto ortopedico rizzoli/osteosarcoma-2 protocol: an updated report. J Clin Oncol 2000; 18:4016.
Schwartz CL, Wexler LH, Devidas M, et al. P9754 therapeutic intensification in non-metastatic osteosarcoma: a COG trial (abstract). Proc Am Soc Clin Oncol 2004; 23:798a
Ferrari S, Ruggieri P, Cefalo G, Tamburini A, Capanna R, Fagioli F, Comandone A, Bertulli R, Bisogno G, Palmerini E, Alberghini M, Parafioriti A, Linari A, Picci P, Bacci G.Neoadjuvant chemotherapy with methotrexate, cisplatin, and doxorubicin with or without ifosfamide in nonmetastatic osteosarcoma of the extremity: an Italian sarcoma group trial ISG/OS. J Clin Oncol. 2012 Jun 10;30(17):2112-8. doi: 10.1200/JCO.2011.38.4420..
Daw NC, Neel MD, Rao BN, Billups CA, Wu J, Jenkins JJ, Quintana J, Luchtman-Jones L, Villarroel M, Santana VM.Frontline treatment of localized osteosarcoma without methotrexate: results of the St. Jude Children's Research Hospital OS99 trial . Cancer. 2011 Jun 15; 117(12):2770-8. doi: 10.1002/cncr.25715.
Van Dalen EC, van As JW, de Camargo B. Methotrexate for high-grade osteosarcoma in children and young adults . Cochrane Database Syst Rev. 2011 May 11 ;( 5):CD006325.
Holmboe L, Andersen AM, Mørkrid L, Slørdal L, Hall KS. High dose methotrexate chemotherapy: pharmacokinetics, folate and toxicity in osteosarcoma patients. Br J Clin Pharmacol. 2012 Jan; 73(1):106-14.
Lee KM, Lee HW, Kim SY, Lee HJ, Kim DH, Cho J, Kim DH, Lim JS, Lee JK, Lee JA. Two pediatric osteosarcoma cases with delayed methotrexate excretion: its clinical course and management. Cancer Res Treat. 2011 Mar; 43(1):67-70. doi: 10.4143/crt.2011.43.1.67.
Mahadeo KM, Santizo R, Baker L, Curry JO, Gorlick R, Levy AS. Ambulatory high-dose methotrexate administration among pediatric osteosarcoma patients in an urban, underserved setting is feasible, safe, and cost-effective. Pediatr Blood Cancer. 2010 Dec 15;55(7):1296-9. doi: 10.1002/pbc.22772.
Collins M, Wilhelm M, Conyers R, Herschtal A, Whelan J, Bielack S, Kager L, Kühne T, Sydes M, Gelderblom H, Ferrari S, Picci P, Smeland S, Eriksson M, Petrilli AS, Bleyer A, Thomas DM. Benefits and adverse events in younger versus older patients receiving neoadjuvant chemotherapy for osteosarcoma: findings from a meta-analysis. J Clin Oncol. 2013 Jun 20; 31(18):2303-12. doi: 10.1200/JCO.2012.43.8598.
Kudawara I, Aoki Y, Ueda T, Araki N, Naka N, Nakanishi H, Matsumine A, Ieguchi M, Mori S, Myoui A, Kuratsu S, Hashimoto N, Yoshikawa H. Neoadjuvant and adjuvant chemotherapy with high-dose ifosfamide, doxorubicin, cisplatin and high-dose methotrexate in non-metastatic osteosarcoma of the extremities: a phase II trial in Japan. J Chemother. 2013 Feb; 25(1):41-8.
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| Issue | Vol 8, No 1 (2014) | |
| Section | Articles | |
| Keywords | ||
| Necrosis Neoadjuvant chemotherapy Osteosarcoma | ||
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