Can cure in patients with osteosarcoma be achieved exclusively with chemotherapy and abrogation of surgery?

Abstract

BACKGROUND Contemporary therapy for osteosarcoma is comprised of initial treatment with chemotherapy and surgical extirpation of the primary tumor in the affected bone. In view of the major advances forged by chemotherapy in the treatment of the primary tumor, an attempt was made to destroy the tumor exclusively with this therapeutic modality and abrogate surgery. METHODS Thirty‐one consecutive patients were treated. All had localized disease (absence of metastases) at the time of diagnosis. Initial treatment with chemotherapy was comprised of high‐dose methotrexate and leucovorin rescue (MTX‐LF) in 3 patients and intraarterial cisplatin in 28 patients. Clinical, radiologic, angiographic, radionuclide, and histologic investigations were utilized to assess the efficacy of treatment. After a response at 3 months, entry into the study was permitted and treatment was maintained for a total of 18–21 months with a combination of agents comprised of MTX‐LF, intraarterial cisplatin, and doxorubicin. Patients were monitored closely for disease recurrence with the investigations outlined earlier. Two informed consents were required: one at the time of diagnosis and another at 3 months after the initial response had been attained. RESULTS Only 3 of 31 patients were cured with the administration of chemotherapy alone. Local recurrence and pulmonary metastases were not reported to develop in these 3 patients during a follow‐up period of 204+ to 225+ months. Four other patients also possibly were cured with chemotherapy alone. At their request, several months after the cessation of chemotherapy, they underwent surgical extirpation of the tumor. No evidence of viable tumor was found. These patients remained free of disease for 192+ to 216+ months. Thus, only seven patients did not develop local recurrence and/or pulmonary metastases. Among the remaining 24 patients, 9 developed local recurrences without pulmonary metastases 14–74 months (median, 30 months) after the initial response. Eight of the nine patients were rendered tumor free by extirpation of the local recurrence. Two of these eight patients subsequently died, one of the acquired immunodeficiency syndrome (AIDS) and the other of varicella septicemia. The ninth patient refused amputation and died of metabolic complications. Three other patients developed local recurrences 20–69 months and pulmonary metastases 10–98 months after achievement of the initial response. These patients were rendered tumor free by extirpation of the local recurrence and metastasectomy. One of these patients also later died of AIDS. In the remaining 12 patients, local recurrences developed 5–29 months (median, 14 months) after the initial response was achieved. The patients also developed pulmonary metastases 11–60 months after the initial response. In eight patients the local recurrences were extirpated and metastasectomy was performed; however, these patients later died of recurrent pulmonary metastases. The remaining four patients refused to undergo extirpation of the local recurren...

Surgical treatment of primary malignant tumors of the sacrum

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“…Surgical excision is the standard local control, although radiation has been used for local control mostly in patients who refuse surgery or whose tumors are deemed unresectable. However, the EFS for those patients remains poor compared with the EFS for patients undergoing surgical resection with a 5-year EFS less than 30% [8].…”

Bufalin induces apoptosis in the U-2OS human osteosarcoma cell line via triggering the mitochondrial pathway

“…OS is prone to aggressive biological behavior and development of distant metastasis (3)(4)(5). The currently used treatment for OS is neo-adjuvant chemotherapy followed by surgical resection, which has improved the five-year survival rate from 20 to 60% (6,7). However, OS cells frequently display multi-drug resistance to chemotherapeutic drugs, which poses a considerable limitation to the clinical curative effect and long-term survival (8).…”