High-dose methotrexate and HELP [Holoxan (ifosfamide), Eldesine (vindesine), platinum] - doxorubicin in non-metastatic osteosarcoma of the extremity: A French multicentre pilot study

This study evaluates histological response, long-term outcome, and toxicity in an intensive chemotherapy program given before surgery. Patients and methods: Sixty-two patients (39 males, 23 females; median age 14) with biopsy, chest computerised-tomography, technetium bone-scan and magnetic resonance imaging, were enrolled. Primary localisations were femur (44%) and tibia (26%). Induction chemotherapy involved seven courses of high-dose methotrexate and two courses of HELP (ifosfamide, eldesine (vindesine), cisplatin (platinum)-doxorubicin. After surgery, patients received six courses of high-dose methotrexate and two courses of HELP-doxorubicin. Results: Pre- and postoperative toxicities were similar. Fifty-nine patients underwent surgery: histological response was good in thirty-eight patients (64%) and poor in twenty-one (36%). Median follow-up is 57 months (range 30-80), with 77% overall survival and 59% progression-free survival. In a multivariate analysis, age under 10 years is the only prognostic factor that significantly correlates with outcome. Conclusions: This regimen appears to increase histological necrosis, but associates with severe toxicity. Results for patients with less necrosis at surgery are encouraging. Future trials should determine the minimum effective doses to reduce toxicity. New drugs should be added.