Neoadjuvant and adjuvant chemotherapy with high-dose ifosfamide, doxorubicin, cisplatin and high-dose methotrexate in non-metastatic osteosarcoma of the extremities: a phase II trial in Japan

Abstract

From 1997 to 2003, 40 patients (all <40 years of age) with non-metastatic osteosarcoma of the extremities were treated with OOS-D and definitive surgery. Two cycles of doxorubicin 90 mg/m² plus cisplatin 120 mg/m² and ifosfamide 15 g/m² were given as neoadjuvant chemotherapy, and two cycles of doxorubicin/cisplatin and ifosfamide, and two cycles of high-dose methotrexate (10–12 g/m²) were given post-operatively. All patients underwent limb salvage surgeries, and 66% showed good response to neoadjuvant chemotherapy. With a median follow-up period of 117 months, 31 of the evaluable 40 patients were continuously disease-free, 7 were currently alive with no evidence of disease, and 2 died of disease. There was no local recurrence. The 5-year event-free and overall survival rates were 83 and 98%, respectively. The 10-year event-free and overall survival rates were 80 and 95%, respectively. The major form of toxicity was haematological one.

Keywords:

• Osteosarcoma
• Chemotherapy
• Ifosfamide
• Limb salvage surgery

The authors thank Ms Yasuko Suzuki for correcting of this manuscript and thank the following orthopedic surgeons for providing assistance with the clinical follow-up: Dr Masanari Aono, Dr Satoshi Takenaka, Dr Susumu Joyama, and Dr Yasuo Beppu.