Neoadjuvant chemotherapy for osteosarcoma of the extremities in patients aged 41–60 years

Figures & data

Table 1.  Characteristics of the 34 patients in the study, and 5-year DFS

Variable	No. of cases	5-year DFS (%)	P-value
Sex
Male	20	55	0.7
Female	14	57
Age
41–50	20	65	0.2
51–60	14	43
Pathologic fracture
Yes	5	55	0.9
No	29	60
Alkaline phosphatase
Normal	22	59	0.6
Elevated	12	50
Site
Femur	19	60	0.9
Tibia	11	50
Humerus	2	50
Fibula	2	50
Size
< 200 mL	20	65	0.3
< 200 mL	14	43
Histology
Osteoblastic	18	50	0.06
Chondroblastic	3	67
Fibroblastic	7	50
Unclassified	2	50
Telangiectatic	3	100
Small cell	1	0
Surgerya
Limb salvage	30	57	0.8
Amputation	3	67
Surgical marginsa
Adequate	31	61	0.2
Inadequate	2	40
Histological responsea
Good	16	55	0.4
Poor	17	47
Mean dose intensitya
< 80%	18	61	0.4
< 80%	15	47

^aThe patient who died from toxicity before surgery has not been included.

Table 2.  Comparison of characteristics and dose intensity of treatment between patients aged 41-60 years and patients younger than 41

Variable	Age 41–60 (n = 34)	Age < 41 (n = 296)	P-value
Gender
Male	20 (0.6)	168 (0.6)	0.7
Female	14 (0.4)	128 (0.4)
Pathological fracture
Yes	5 (0.15)	46 (0.15)	0.9
No	29 (0.9)	250 (0.8)
Alkaline phosphatase
Normal	21 (0.6)	165 (0.6)	0.6
Elevated	13 (0.4)	131 (0.4)
Site
Femur	19 (0.6)	153 (0.5)	0.9
Tibia	10 (0.3)	80 (0.3)
Humerus	2 (0.06)	42 (0.14)
Fibula	2 (0.06)	19 (0.06)
Other Bones	0	2 (0.07)
Size
< 1/3 of the involved bone	21 (0.6)	150 (0.5)	0.3
< 1/3 of the involved bone	13 (0.4)	146 (0.5)
Histology
Osteoblastic	18 (0.5)	181 (0.6)	0.06
Chondroblastic	3 (0.09)	36 (0.12)
Fibroblastic	6 (0.18)	44 (0.15)
Unclassified	2 (0.06)	29 (0.1)
Telangiectatic	3 (0.09)	4 (0.01)
Small cell	1 (0.03)	2 (0.006)
Mean dose intensity
< 80%	18 (0.5)	155 (0.5)	0.4
< 80%	15 (0.5)	141 (0.5)

Figure 1. Chemotherapy protocol

Figure 2. Comparison of EFS in the two groups of patients

Table 3.  Comparison between results obtained in 34 ^a patients of the present study (Jan 1994–Dec 1999) and those obtained in 296 younger patients treated during the same period (Apr 1994–Aug 1998) with Rizzoli's conventional protocols (IOR/OS-4 and IOR/OS-5)

	Age 41–60 n = 33		Age < 41 n = 296		P-value
	%	(95% CI)	%	(95% CI)
Limb salvage	91	(69–93)	92	(59–94)	0.9
Amputation	9	(1–18)	7	(1–21)
Rotation-plasty	0		2	(0.8–1.9)
Good histological response	48	(36–60)	65	(48–69)	0.4
Poor histological response	52	(41–62)	36	(18–57)
5-year DFS	56	(50–64)	59	(40–72)	0.3
5-year OS	71	(60–76)	71	(62–77)
Local recurrences	12	(1–18)	6	(1–36)	0.2
Months to relapse, median (range)	17	(6–30)	25	(7–59)
Months to death, median (range)	30	(11–48)	36	(3–90)

^a1 patient who died from chemotherapy toxicity before surgery was excluded