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

Figures & data

Table 1 Patient Data

Case No.	Age (y)	Sex	Tumor Size (cm)	Morbid Site	MRI Tumor Response Before Surgery	Surgical Margins	Histopathologic Response	Diagnosis Date	Surgery Type	Follow-Up (Month)	First Relapse	Status
1	62	F	<8	Unclear	+27.4%, PD	R0	<90%	5/19/2010	1	42		CDF
2	19	M	<8	Ilium	−35.1%, PR	R0	>90%	10/4/2010	2	46	Jan. 2014	DOD
3	14	M	<8	Unclear	+14.6%, SD	R0	95%	7/23/2011	2	52		CDF
4	53	F	>8	Sacrum	−7.3%, SD	R1	<90%	6/30/2012	4	57	Feb. 2015	NED
5	15	M	<8	Ilium	−32.7%, PR	R0	>90%	10/28/2012	2	93		CDF
6	21	F	7	Ilium	+25.9%, PD	R0	>90%	4/24/2013	2	87		CDF
7	16	M	>8	Unclear	+8.6%, SD	R1	<90%	9/22/2013	2	37	Aug. 2015	DOD
8	36	F	9	Pubis	−24.1%, SD	R0	>90%	4/14/2014	2	76		CDF
9	69	M	12	Ischium	+43.7% PD	R1	<90%	5/17/2014	3	15	Jan. 2015	DOD
10	12	F	<8	Unclear	−37.4%, PR	R0	99%	8/21/2014	2	72		CDF
11	41	M	<8	Pubis	+33.5%, PR	R0	>90%	3/6/2015	2	34		CDF
12	47	M	<8	Ilium	+16.6%, SD	R0	95%	6/30/2015	2	62	Dec. 2019	DOD

Notes: Surgical type = 1) primary lower limb amputation; 2) lower limb salvage surgery; 3) secondary amputation and reresection due to local recurrence; 4) revision surgery due to periprosthetic infection.

Abbreviations: CAI, cisplatin arterial infusion; PR, partial response; PD, progressive disease; SD, stable disease; CAP, cisplatin arterial perfusion; CDF, continuously disease free; NED, no evidence of disease; DOD, died of disease.

Figure 1 The individualized pelvic osteosarcoma treatment protocol combined cisplatin arterial infusion, multidrug systematic chemotherapy and resection surgery (CAI + MSC + S).

Figure 2 (A) Pelvis X-ray of a 36-year-old female with an osteosarcoma in the pubis. (B) and (C) Fat-saturated T1- and T2-weighted coronal slices of contrast-enhanced MRI showing the maximum diameter of the tumor at the first diagnosis, which showed heterogeneous enhancement, thick septa and obscure boundaries of the tumor. (D) and (E) MRI reevaluation after completion of the neoadjuvant CAI + MSC regimen, showing thin septa, clear boundaries and stable disease according to RECIST 1.1 with a decrease in the tumor diameter. (F) Pelvis plain X-ray of this patient. (The identifiable captions in these images are occluded.).

Table 2 Overall Survival (OS) and Event-Free Survival (EFS) Rate

Variables	1 y	5 y
All patients – OS	91.7%	57.8%
All patients – EFS	91.7%	52.5%
Good responders – OS	100.0%	68.6%
Good responders – EFS	100.0%	68.6%
Poor responders – OS	75.0%	50.0%
Poor responders – EFS	75.0%	25.0%
Patients with tumor size ≥8 cm – OS	75.0%	50.0%
Patients with tumor size ≥8 cm – EFS	75.0%	25.0%
Patients with tumor size<8 cm – OS	100.0%	62.5%
Patients with tumor size<8 cm – EFS	100.0%	64.3%
R0 resection – OS	85.7%	70.0%
R0 resection – EFS	88.9%	71.1%
R1 resection – OS	66.7%	33.3%
R1 resection – EFS	66.7%	33.3%

Note: Confidence Interval = 95%

Figure 3 The Kaplan-Meier survival curve for overall survival (OS) and event-free survival (EFS) rates of 12 pelvic osteosarcoma patients treated with the CAI + MSC + S protocol.

Table 3 Statistics of CAI-Related Adverse Events

Adverse Events	No. of Courses	Percentage of Patients with Grade 3–4 Adverse Events
Skin hyperpigmentation	12.5% (3/24)	0% (0/12)
Pelvic soft tissue necrosis (muscle)	4.2% (1/24)	0% (0/12)
Pelvic pain	16.7% (4/24)	8.3% (1/12)
Nausea and vomiting	75.0% (18/24)	41.7% (5/12)
Anemia	8.3% (2/24)	8.3% (1/12)
Increase in creatinine level	8.3% (2/24)	0% (0/12)
Increase in aminotransferase level	4.2% (1/24)	0% (0/12)
Infusion related reaction	29.2% (7/24)	0% (0/12)

Table 4 Synopsis of IA CDDP Information Reported in the Literature

Authors	Type of Study	No. of Patients	Ages (y)	Sites	Metastases	Preoperative CDDP Courses No.	>90% TN	OS	EFS
Winkler et al and Fuchs et al^Citation30,Citation34	Nonrandomized, 2 arms	50	<40	All	Included	2	68%	67% at 10 y	63% at 10 y
Ferrari et al^Citation33	Single arm	164	<40	Extremity	Excluded	2	NA	72% at 8 y	63% at 8 y
Ferrari et al^Citation33	Randomized, 2 arms	59	<40	Extremity	Excluded	2	64%	61% at 8 y	54% at 8 y
Rha et al^Citation35	Single arm	37	8~41	Extremity	?	3	75%	78% at 3 y	55% at 3 y
Bacci et al^Citation32	Randomized, 2 arms	40	<40	Extremity	Included	2	77%	NA	26% at 5 y
Bacci et al^Citation32	Randomized, 2 arms	72	<40	Extremity	Included	2	80%	NA	61% at 5 y
Wilkins et al^Citation37	Single arm	47	<21	Extremity	Excluded	3–5 (response dependent)	87%	92% at 10 y	84% at 10 y
Wilkins et al^Citation36	Single arm	62	<22	Extremity	Excluded	3–5 (response dependent)	87%	93% at 10 y	86% at 10 y
Xie et al^Citation13	Nonrandomized, 2 arms	48	NA	Extremity	Included	3	63%	64% at 5 y	60% at 5 y
Hu et al (Current study)	Single arm	12	11~69	Pelvis	Excluded	2	66.7%	57.8% at 5 y	52.5% at 5 y

Abbreviations: IA, intraarterial; CDDP, cisplatin; TN, tumor necrosis; OS, overall survival; EFS, event-free survival.

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