Petrilli, Antonio Sergio, Gentil, Fernando C., Epelman, Sidnei, Lopes, Luiz Fernando, Bianchi, Alois, Lopes, Ademar, Figueiredo, Marco Tullio De Assis, Marques, Elvira, De Bellis, Normando, Consentino, Elio, Prospero, Donato, De Camargo, Olavo Pires, Oliveira, Nanni R., Franco, Eduardo, and Jaffe, Norman
Osteosarcoma is a form of bone cancer, and is especially common in younger people. The primary form of treatment is surgical removal of the affected bone, which often requires amputation of the limb. However, it has been found that the addition of adjuvant chemotherapy to the surgical treatment not only improves survival, but in some cases may make it possible for more conservative surgery and preservation of a limb. A study was conducted to evaluate the effectiveness of chemotherapy and surgery in the treatment of osteosarcoma; the study also evaluated patient and treatment factors which correlated with improved survival. Ninety-two patients, ranging in age from four to 28 years, were treated with cisplatin delivered into an artery. Twenty-eight patients showed sufficiently great responses to the chemotherapy that they were given extra courses of chemotherapy in hopes of making more conservative surgery possible. A week after the third infusion of cisplatin, the cancer was surgically removed, and after surgery the patients were treated with intravenous cisplatin and doxorubicin. It was possible to evaluate 62 surgical specimens. Tumor destruction greater than 90 percent was observed in 16 of 40 patients who received three or fewer chemotherapeutic courses prior to surgery and in 17 of 20 patients who received four or more. Conservative surgery was possible in 68 percent of the patients who received four or more courses, in contrast with only 23 percent of the patients who received fewer preoperative courses of chemotherapy. Metastatic spread of cancer to the lungs was common, affecting 36 patients; two patients developed metastatic cancer in other bones. A total of 46 patients - exactly half -remain free of disease at follow-up periods ranging from 18 to 78 months after diagnosis. Male patients suffered greater likelihood of recurrence and also greater likelihood of death from osteosarcoma. The degree of tumor necrosis, or tissue destruction, achieved after the preoperative chemotherapy was also predictive of recurrence; patients with low necrosis were more likely to suffer recurrence. The appearance of the tumor under the microscope also predicted the likelihood of recurrence, and cancers which did not have the classic appearance of osteosarcoma were more likely to recur. (Consumer Summary produced by Reliance Medical Information, Inc.)