Intraarterial Cisplatin and intravenous adriamycin in nonmetastatic osteosarcoma of the extremities: a single institution experience in Taiwan.

Background: For nonmetastatic osteosarcoma of the extremities, the optimal treatment now consists of multiagent neoadjuvant and adjuvant chemotherapy and limb-sparing surgical procedures. The degree of tumor necrosis after neoadjuvant chemotherapy is one of the most important prognostic indicators. Intraarterial cisplatin and intravenous adriamycin could achieve a good initial tumor response and convert the response to an ultimate cure.

Methods: Between January 1989 and July 2004, 16 patients with nonmetastatic osteosarcoma of the extremities received intravenous adriamycin and intraarterial cisplatin monthly for 2-5 courses, based on achievement of a maximized angiographic response, followed by limb salvage surgery and then adjuvant intravenous chemotherapy with adriamycin and cisplatin. After resection, if patients had a good response (the extent of tumor necrosis was > or =90%), the same regimen was administered intravenously every three weeks for a total of six courses of chemotherapy. Poor responders (tumor necrosis <90%) were treated with a regimen of high-dose methotrexate with leucovorin rescue (HD-MTX) or ifosfamide, cisplatin, and etoposide (ICE).

Results: Patients received an average of four cycles of neoadjuvant intraarterial chemotherapy. Sixteen patients underwent limb-preservation surgery and 12 had >90% tumor necrosis. With an average follow-up of 93.5 months, 8 patients were continuously disease -free, 6 died of disease and 2 had no evidence of disease 112 and 182 months respectively after relapse. The 5-year overall survival rate was 61%. No patient developed clinically detectable cardiac toxicity or ototoxicity after adriamycin and cisplatin administration. Febrile neutropenia occurred infrequently.

Conclusion: This study shows the effectiveness of treating nonmetastatic osteosarcoma of the extremities with intraarterial cisplatin and intravenous adriamycin infusion in Taiwan. However, the number of patients evaluated and treated in a single hospital was obviously too few to be considered statistically robust and this regimen deserves further testing in a multi-institutional fashion.