Neoadjuvant chemotherapy for osteosarcoma of the extremities in patients aged 41-60 years - Outcome in 34 cases treated with Adriamycin, Cisplatinum and Ifosfamide between 1984 and 1999

Background It is unclear whether adult patients with high-grade non-metastatic osteosarcoma of the extremities, treated with neoadjuvant chemotherapy according to protocols designed for adults, have a different outcome than younger patients treated with conventional protocols. Patients and methods From 1994 through 1999, we treated 34 patients with non-metastatic osteosarcoma of the extremities. These patients were aged mean 50 years (41 - 60), and received 4 cycles of multidrug chemotherapy (1 preoperatively and 3 postoperatively). Each cycle consisted of a combination of Cisplatin/ Adriamycin, Ifosfamide/Cisplatinum and Ifosfamide/ Adriamycin. 30 patients had limb salvage and 3 underwent amputation. During preoperative treatment, 1 died of toxicity. 16 patients had a good histological response to chemotherapy (>= 90% tumor necrosis) and 17 had a poor response. Results and interpretation With a median follow-up of 8 (5 - 11) years, 19/ 33 patients remained continuously disease-free and 14 relapsed (10 with metastases, 3 with local recurrence and metastases, and 1 with local recurrence alone). After further treatments, 2/ 14 relapsed patients are alive and disease- free, 11 died of tumor, and 1 is alive with uncontrolled disease. 5- year event-free survival and overall survival were 56% and 70%, respectively. These results, which are similar to those of 296 patients under 40 years of age who were treated with conventional chemotherapy (5- year EFS 59% and year OS 70%), indicate that neoadjuvant chemotherapy improves prognosis and also reduces amputations in patients aged over 40 with osteosarcoma of the extremities.