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Multiinstitutional phase II study of neoadjuvant chemotherapy for osteosarcoma (NECO study) in Japan: NECO-93J and NECO-95J

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

Osteosarcoma is the most frequent primary malignant bone tumor. In Europe and the United States, its prognosis has been greatly improved by the use of multimodal treatment, including preoperative and postoperative chemotherapy as well as surgery. In Japan, however, only a few clinical studies on osteosarcoma have been carried out.

Methods

To evaluate the efficacy of neoadjuvant chemotherapy on nonmetastatic, operable osteosarcoma arising in the extremities, a prospective multiinstitutional phase II trial, the Neoadjuvant Chemotherapy for Osteosarcoma (NECO) study, was conducted. Preoperative chemotherapy included high-dose methotrexate (HD-MTX), cisplatin (CDDP), and adriamycin (ADR). If the induction therapy was assessed as not effective, high-dose ifosfamide (IFO) was added to the chemotherapy regimen. A total of 124 patients were enrolled in this trial, and ultimately 113 patients were eligible.

Results

The 5-year overall survival (OAS) and event-free survival (EFS) rates in the NECO study were 77.9% and 65.5%, respectively. A good histological response to the induction chemotherapy resulted in favorable OAS (78.7%). The patients assessed as poor histological responders with progressive disease after the induction chemotherapy exhibited comparable outcomes (OAS 89.5%, EFS 68.2%). There were no significant differences between the OAS and EFS rates of the patients in terms of response to preoperative chemotherapy.

Conclusions

We analyzed the results of the intensive neoadjuvant chemotherapy and the effects of adding IFO on patients with osteosarcoma in Japan. The results suggest efficacy of the high-dose IFO addition to the standard three-drug chemotherapy regimen. However, a randomized clinical study is needed to establish the true impact of IFO on patients with osteosarcoma.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Yukihide Iwamoto & Kazuhiro Tanaka

  2. Department of Orthopaedic Surgery, Hokkaido Cancer Center, Hokkaido, Japan

    Kazuo Isu & Shinya Yamawaki

  3. Department of Orthopaedic Surgery, Okayama University, Okayama, Japan

    Akira Kawai

  4. Department of Orthopaedic Surgery, Chiba Cancer Center, Chiba, Japan

    Shin-Ichiro Tatezaki & Takeshi Ishii

  5. Department of Orthopaedic Surgery, Kanagawa Cancer Center, Kanagawa, Japan

    Kazuyoshi Kushida

  6. Department of Orthopaedic Surgery, National Cancer Center Hospital, Tokyo, Japan

    Yasuo Beppu

  7. Department of Orthopaedic Surgery, Sapporo Medical University, Hokkaido, Japan

    Masamichi Usui

  8. Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan

    Akio Tateishi

  9. Department of Orthopaedic Surgery, Yonago Medical Center, Tottori, Japan

    Kiyoo Furuse

  10. Department of Orthopaedic Surgery, Tottori University, Tottori, Japan

    Takeshi Minamizaki

  11. Department of Orthopaedic Surgery, Cancer Institute Hospital, Tokyo, Japan

    Noriyoshi Kawaguchi

Authors
  1. Yukihide Iwamoto
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  2. Kazuhiro Tanaka
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  3. Kazuo Isu
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  4. Akira Kawai
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  5. Shin-Ichiro Tatezaki
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  6. Takeshi Ishii
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  7. Kazuyoshi Kushida
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  8. Yasuo Beppu
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  9. Masamichi Usui
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  10. Akio Tateishi
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  11. Kiyoo Furuse
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  13. Noriyoshi Kawaguchi
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  14. Shinya Yamawaki
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Additional information

Japan Bone Tumor Chemotherapy Study Group

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Iwamoto, Y., Tanaka, K., Isu, K. et al. Multiinstitutional phase II study of neoadjuvant chemotherapy for osteosarcoma (NECO study) in Japan: NECO-93J and NECO-95J. J Orthop Sci 14, 397–404 (2009). https://doi.org/10.1007/s00776-009-1347-6

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  • DOI: https://doi.org/10.1007/s00776-009-1347-6

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