Preoperative chemotherapy for osteogenic sarcoma:Selection of postoperative adjuvant chemotherapy based on the response of the primary tumor to preoperative chemotherapy

Abstract

Since June 1978, 57 patients with primary osteogenic sarcoma of an extremity were treated with high-dose methotrexate (HDMTX) and citrovorum factor rescue (CFR), Adriamycin, and the combination of bleomycin, cyclophosphamide and dactinomycin (BCD) given for 4-16 weeks prior to definitive surgery. Histologic examination of the resected primary tumor determined the effect of preoperative chemotherapy with many primary tumors showing greater than 90% tumor necrosis attributable to preoperative chemotherapy. A l l patients having this favorable effect of chemotherapy on the primary tumor were continued on the same chemotherapy regimen postoperatively (regimen B). However, in those patients not having a good effect of preoperative chemotherapy on the primary tumor, H D M T X with CFR was subsequently deleted from their postoperative chemotherapy and they were placed on a regimen containing cisplatinum at the dose of 120mg/M2 with mannitol diuresis combined with Adriamycin i n addition to BCD (regimen A). In the current study, 35 of the 57 patients did not demonstrate a good effect of chemotherapy on the primary tumor and were assigned to regimen A postoperatively. Of these 35 patients, 32 (91%)) have remained continuously free of recurrent or metastatic disease from 6-34 months following the start of therapy. Among the 22 remaining patients having a good histologic response and treated with regimen B postoperatively, there has been only one relapse in a patient who had a local recurrence in the area of an inadequately resected primary tumor three months after the cessation of chemotherapy. Thus, 53 of 57 patients (93%) are continuously with no evidence of recurrent or metastatic disease from 6-35 months (median, 20 months) from the start of treatment. This study demonstrates the value of thorough histologic examination in predicting survival i n responding patients and i n helping identify patients whose disease-free survival rate can be substantially increased if they are given alternative postoperative adjuvant chemotherapy after failing to have a good response to preoperative chemotherapy. This individualized chemotherapeutic strategy has yielded the highest disease free survival raw reported to date for osteogenic sarcoma.

Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy

“…These cells have been described in connection with regression observed in osteosarcoma. 8,9 Carcinomas of the breast 32 and esophagus, 12 being derived from the mononuclear phagocytic system, are believed to be particularly active in the clearance of apoptotic cells. 34 Their presence in the patients treated with chemotherapy could be an indication of areas in which tumor cells underwent apoptosis induced by the chemotherapeutic agent.…”

“…In Phase II studies of neoadjuvant chemotherapy, patients with clinical responses have had a significantly better prognosis than nonresponding patients, particularly when a complete (UICC R0) resection was performed. [3][4][5][6][7] Histologic tumor regression after chemotherapy is believed to be an important objective parameter and has been studied in patients with osteosarcoma, 8,9 patients with carcinoma of the prostate, 10 lung, 11 esophagus, 12 or breast, 13 and in patients with squamous cell carcinoma of the head and neck. 14 The findings of these studies are difficult to apply to gastric carcinoma, and the few studies describing histologic changes in gastric carcinoma after neoadjuvant chemotherapy [15][16][17] are difficult to interpret, because tumors were staged and treated differently and because specimens were processed and graded differently with respect to regression.…”

Magnetic resonance imaging of bone marrow in oncology, Part 2

“…a Sagittal T1-weighted SE MR image shows typical serpiginous rims with low signal intensity surrounding regions of fatty marrow in distal femur and proximal tibia. b Sagittal fatsuppressed T2-weighted MR image shows a double-line sign (arrow), consisting of an inner band of high signal intensity and an outer band of dark signal adjuvant chemotherapy portends patient prognosis in osteogenic sarcoma [54,55]. In a study of 50 cases of osteogenic sarcoma and Ewing sarcoma by Dyke et al [50], quantitative estimates of tumor necrosis obtained using dynamic contrast-enhanced MRI were shown to be strongly correlated with the percentage of necrosis determined by pathologic evaluation (using the Huvos grading system), particularly in making the clinically relevant distinction between those tumors that are less or more than 90% necrotic.…”

Second malignant neoplasms in long‐term survivors of osteosarcoma

“…[12][13][14][15] The protocols consisted of multiagent chemotherapy and/or surgery totaling 40 weeks with some variations in the actual treatment period. Patients treated according to the T4 protocol received adjuvant chemotherapy following surgical resection of their primary tumor.…”