Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Pusan, Korea.
ABSTRACT
PURPOSE: The survival rate according to the methods of treatment was significantly higher in the osteosarcoma patients in which limb salvage operation with neoadjuvant chemotheraphy. The purpose of this study is to analyze the results of treatment in the Stage IIB osteosarcoma patients who treated with modified T10 protocol.
MATERIALS AND METHODS: From Jun. 1990 to Oct. 1997, thirty eight cases of Enneking's stage IIB osteosarcoma in extremities, were treated with neoadjuvant chemotherapy by modified T10 protocol of Rosen. Their mean age was 22 years old (8 months to 55 years). And average duration of follow up is 29 months(10 manths to 88 months). The preoperative chemotherapy consisted of high dose methotrexate(HDMTX)(above 12 years old: 8 g/m2, below 12 years old: 12 g/m2), adriamycin(ADR)(30 mg/m2/day x 2), intraarterial cisplatin(CDDP)(100 mg/m2) or ifosfamide (IFO)(1.8 g/m2/day x5). The preoperative tailoring was performed according to the radiologic response after chemotherapy. If the patient revealed good response, we continued the chemotherapy next one more cycle and if not, stoped the chemotherapy or changed the cisplatin to ifosfamide. The postoperative chemotherapy consisted of HDMTX, adriamycin, ifosfamide or cisplatin with 4 cycles.
According to the pathologic response to the pre-operative chemotherapy, we use HDMTX, ADR, CDDP in good response group and HDMTX, ADR, IFO in poor response group respectively.
RESULTS: On the latest follow up, 27 patients were continuous disease free(CDF 27/38), 4 patients were alive with disease(AWD) and 6 patients were died of disease(DOD) and I case was died of bone marrow and hepatic failure due to complication of chemotherapy. According to Kaplan-Meier's plot, the overall 5 years survival rate was 73.6%, and continuous disease free 5 years survival rate being 64%. The comparison of continuous disease free survival rates between good radiologic response group and poor response group showed 73% and 55%. The continuous disease free survival rates according to the pathologic response in good response group and poor were 90 % and 55%. During the chemotherapy, the most serious complications were leukocytopenia and bone marrow failure. These were controled by granulocyte colony stimulating factor(G-CSF) and leukotrophic agent. Other minor complications were nausea, vomiting, headache and extrapyramidal symptom, which were easily managed by simple conservative measure.
CONCLUSION: It was obtained that the overall 5 years survival rate was 73.6%, and continuous disease free 5years survival rate being 64% with modified T10 protocol.
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