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KMID : 0613319990050020112
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Journal of the Korean Bone and Joint Tumor Soceity
1999 Volume.5 No. 2 p.112 ~ p.123
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Stage ⅡB Osteosarcoma in Extremity -The Result of Neoadjuvant Chemotherapy and Analysis of Prognostic Factors-
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Lee Sang-Hoon
Lee Chang-Seop
Kim Han-Soo
Jeong Jin-Young
Lee Han-Koo
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Abstract
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We retrospectively reviewed our experience with preoperative chemotherapy in stage ⅡB extremity osteosarcoma to evaluate the results of preoperative chemotherapy and to determine prognostic factors. Between September 1987 and October 1996, 49 patients were treated with neoadjuvant and adjutant chemotherapy, and surgery for the previously untreated stage ⅡB osteosarcoma. The median age was 17.0 years and the median follow-up was 50 months (from 12 to 111 months). All patients received intensive preoperative chemotherapy according to one of our two protocols. One protocol was intraarterial cisplatin (130 ㎎ /m2), 3 to 6 cycles (23 patients) and another was high-dose methotrexate (8 g/m2, day 1 and 8), adriamycin (25 ㎎/m2, day 16-18) and cisplatin (75 ㎎/m2, day 16), 2 cycles (26 patients). All except one were followed by surgical treatment (limb salvage in 44 patients, amputation in 4) and postoperative chemotherapy without tailoring method. The analyzed prognostic factors were: age, sea, location, tumor size, serum alkaline phosphatase (ALP), our two neoadjuvant chemotherapy Protocols, surgical margin and pathologic response. Forty-four (90%) patients underwent limb-salvage operation with at least marginal margin. The 5-year continuous disease-free survival rate of all patients was 63.6％. The only statistically significant prognostic factor was pathological response to preoperative chemotherapy (above of below 90％; 80.0％ vs 57.1 , p=0.043). The surgical margin was well correlated with the local recurrence rate; marginal margin 21.4％ and wide margin
3.3％. To reduce the number of unfavorable responders and to improve their survival rate, more aggressive chemotherapy may be needed. Also, to decrease the local recurrence, a wider margin is necessary.
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KEYWORD
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Osteosarcoma, Preoperative chemotherapy, Prognostic factors
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