Effect of Cisplatin Arterial Infusion (CAI) on Primary Nonmetastatic Pelvic Osteosarcoma: A Preliminary Study

Abstract

Purpose

The critical role of arterial infusion chemotherapy in the multimodal treatment of extremity bone cancer has been investigated extensively, but few studies have focused on pelvic osteosarcoma. Therefore, we attempted to evaluate the clinical significance of arterial infusion chemotherapy in the treatment of pelvic osteosarcoma.

Patients and Methods

We combined a cisplatin arterial infusion regimen with multidrug systematic chemotherapy as a neoadjuvant protocol for the treatment of pelvic osteosarcoma. The course number and dosage of cisplatin arterial infusion were adjusted to achieve a maximal tumor response evaluated by contrast-enhanced MRI per RECIST 1.1. Good responders received the same systematic combination for postoperative chemotherapy, and poor responders received second-line therapy. Twelve patients with nonmetastatic high-grade pelvic osteosarcoma were included. Survival, chemotherapy response and adverse events data were analyzed.

Results

The mean follow-up period was 56.1 months. Four patients died of refractory tumor progression, and 1 patient with local recurrence had no evidence of disease for 27 months after receiving secondary amputation and resection. Kaplan-Meier survival analysis demonstrated a 57.8% overall survival and 52.5% event-free survival rate at 5 years. Eight of 12 patients had a >90% tumor necrosis rate according to histopathologic examinations. The rates of local adverse events were lower than those reported for extremity osteosarcoma.

Conclusion

Our study initially indicated that the cisplatin arterial infusion regimen was a potential therapy with good tolerance in the treatment of pelvic osteosarcoma.

Keywords:

• osteosarcoma
• pelvis
• cisplatin
• arterial infusion
• chemotherapy toxicity

Acknowledgments

We would like to thank all patients for their devotion to taking unidentified risks in this clinical trial. We are also grateful to the participating orthopedic oncologists and interventional radiologists for their prudence and patience in the therapeutic effect evaluation and the multidisciplinary consultation.

Abbreviations

ADM, adriamycin; CAI, effect of cisplatin arterial infusion; CDDP, cis-diamine-dichloro platinum; CE-MRI, contrast-enhanced MRI; CR, complete response; CTCAE, Common Terminology Criteria for Adverse Events; EFS, event-free survival; ETOP, etoposide; IFO, ifosfamide; IV, intravenous; MSC, multidrug systematic chemotherapy; MTX, methotrexate; OS, overall survival; PD, progressive disease; PR, partial response; RECIST, response evaluation criteria in solid tumors version; S, surgery; SD, stable disease; TNR, tumor necrosis rate; VCR, vincristine.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics Approval and Informed Consent

This study was approved by the ethics committees and the institutional review board of the Second Xiangya Hospital. All patients provided written informed consent for receiving this treatment protocol. The requirement of obtaining specific informed consent for this retrospective study was waived for the reason mentioned before.

Consent for Publication

This study conforms to Declaration of Helsinki. The requirement of obtaining specific informed consent from the patients for the publication of the case presentation and any accompanying images.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

No commercial sponsorship was involved in any part of this study. The authors report no conflicts of interest related to this work.