Abstract
Background: For the treatment of osteosarcoma, the significance of the preoperative cisplatin (CDDP) as single agent has not been assessed in conjunction with prognostic value.
Purpose: To assess the effect of preoperative CDDP as single agent and its impact on the prognosis of the limb osteosarcoma in the multi-institutional group study.
Patients and methods: Forty-seven cases were entered for the study between December 1983 and June 1993 at cooperative institutions. Three cases were eliminated from the study because of presence of lung metastasis at diagnosis. Forty-four cases of stage IIB limb osteosarcoma treated with CDDP as initial preoperative chemotherapy were evaluated in this study. Mean age was 17.1 years old (7–29 yo.), and mean follow up periods of the living patients were 150 months (58–189 mo.). Two to four courses of CDDP (3 mg/kg, mean 2.4 courses) were administered intravenous and/or intraarterial rout as initial preoperative treatment. All the patients underwent postoperative multi-drug combination chemotherapy with CDDP, doxorubicin, with/without HD-MTX. We evaluated the effect of initial preoperative CDDP by synthesizing the results of clinical findings, radiological findings, serum alkaline phosphatase level, and histological findings. Each findings were evaluated into four grades, and final evaluation was done according to our criteria.
Results: Favorable response ((Complete response(CR) and Partial response (PR)) were obtained in 25 patients, and poor response (No change (NC) and Progression of the disease (PD)) were obtained in 19 patients. Survival rate of all patients in this study was 59.1%, and 64.0% in patients with CR and PR effects, and 52.6% in NC and PD groups. No statistical differences were found between the groups (p=0.3886). Necrotic ratios were examined in 20 patients, and average necrotic ratio was 74.5 %. Good histological response (%necrosis > 80%) was obtained in 11 patients and poor response was obtained in 9 patients. Survival rate of the patients with good histological response was 72.7%, and 44.4% in patients with poor histological response, with no statistical differences between the groups (p=0.14).
Discussion: CDDP has been postulated as one of the most effective chemotherapeutic agents for the treatment of osteosarcoma. In this study, we obtained 57% response rate (25/44) by initial preoperative CDDP administration. In this study, local response to single CDDP treatment is not significant prognostic factor. For treatment planning of neoadjuvant chemotherapy, local response should be evaluated after multi-drug combination preoperative regimen to predict patients¡Ç prognosis.
The abstracts were prepared by Professor Jegan Krishnan. Correspondence should be addressed to him at the Flinders Medical Centre, Bedford Park 5047, Australia.
