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Intraarterial Chemotherapy for Extremity Osteosarcoma and MFH in Adults

  • Symposium: Selected Papers Presented at the 2007 Meeting of the Musculoskeletal Tumor Society
  • Published:
Clinical Orthopaedics and Related Research

Abstract

The neoadjuvant treatment of osteosarcoma using intravenous agents has resulted in survival rates of 55% to 77% [3, 5, 6, 20, 22, 35]. We designed a neoadjuvant chemotherapy protocol using combined intraarterial and intravenous agents to treat high-grade osteosarcoma and malignant fibrous histiocytoma of bone in an attempt to improve survival. We report the results of treating 53 adults (age 18–77 years) diagnosed with nonmetastatic extremity osteosarcoma or malignant fibrous histiocytoma. Preoperative chemotherapy consisted of intravenous doxorubicin followed by intraarterial cisplatinum administered repetitively every 3 weeks for three to five cycles, depending on tumor response assessed by serial arteriography. Dose and duration of cisplatin were adjusted for tumor size. After resection, good responders (90% or greater necrosis) underwent treatment with the same agents and poor responders were treated with alternative agents for longer duration. Minimum followup was 24 months (mean, 111 months; range, 24–235 months). Estimated Kaplan-Meier survival at 10 years was 82% and event-free survival was 79%. Forty-one patients (77%) had a good histologic response and 92% (49 of 53) underwent limb-sparing procedures. Local recurrence occurred in two patients (4%). These results compared favorably with those reported in the current literature.

Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Dr. Lorrie Odom, Rocky Mountain Pediatric Hematology Oncology; Dr. Brandt Jamroz, interventional radiologist; Dr. Sanford Peck, pathologist; and the departments of audiology, rehabilitation, and cardiology at Presbyterian/St Luke’s Medical Center. We are especially grateful to Dr. John Cullen for his help in designing the protocol and his continued commitment toward research in pediatric oncology.

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Authors and Affiliations

  1. The Denver Clinic for Extremities at Risk, Presbyterian/St Luke’s Medical Center, 1601 E. 19th Avenue, Suite 3250, Denver, CO, 80218, USA

    Ronald R. Hugate MD, Ross M. Wilkins MD, Cynthia M. Kelly MD, Walt Madsen MD, Ioana Hinshaw MD & Anne B. Camozzi BA

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  1. Ronald R. Hugate MD
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  2. Ross M. Wilkins MD
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  3. Cynthia M. Kelly MD
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Correspondence to Ronald R. Hugate MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Hugate, R.R., Wilkins, R.M., Kelly, C.M. et al. Intraarterial Chemotherapy for Extremity Osteosarcoma and MFH in Adults. Clin Orthop Relat Res 466, 1292–1301 (2008). https://doi.org/10.1007/s11999-008-0252-1

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  • DOI: https://doi.org/10.1007/s11999-008-0252-1

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