The feasibility of neoadjuvant high‐dose chemotherapy and autologous peripheral blood stem cell transplantation in patients with nonmetastatic high grade localized osteosarcoma

Abstract

BACKGROUNDThe primary and secondary objectives of the current study were to improve the ≥ 90% tumor necrosis rate and assess the toxicity profile of the neoadjuvant high‐dose chemotherapy (HDC) regimen, respectively.METHODSTwenty‐two patients with AJCC Stage IIB high‐grade osteosarcoma were included in the current study. Two cycles of an induction chemotherapy regimen including cisplatin, doxorubicin, and ifosfamide followed by HDC and autologous peripheral blood stem cell support or transplantation (APBSCT) were given. After engraftment was achieved, the patients underwent limb‐sparing surgery (LSS) followed by three to six cycles of postoperative chemotherapy depending on the tumor necrosis rate.RESULTSThe median follow‐up, the total duration of treatment, and the time to surgery were 23.7 months, 5.96 months, and 3.03 months, respectively. The necrosis rate was at least 90% in 82% of the cases. The 3‐year overall survival (OS) and disease‐free survival (DFS) rates were 83% and 70%, respectively. Leukopenia, anemia, thrombocytopenia, nausea and emesis, and mucositis were the most frequent Grade 3 and Grade 4 toxicities (according to the National Cancer Institute Common Toxicity Criteria [version 2.0]) of induction, high‐dose, and adjuvant chemotherapies. At the time of last follow‐up, no patient had died of chemotherapeutic toxicity. LSS was performed in all patients. Surgery‐related complications were reported in 3 of 22 patients. Functional scoring results were excellent in eight patients, good in nine patients, fair in two patients, and poor in three patients.CONCLUSIONSThe results of the current Phase II study suggest that neoadjuvant HDC provides a greater than 90% necrosis rate with acceptable toxicity. A short duration of therapy and the feasibility of LSS in all patients are additional advantages of this approach. Cancer 2005. © 2005 American Cancer Society.

Functional outcome in patients with osteosarcoma around the knee joint treated by minimised surgery

“…Thus, new treatment approaches are needed and many interesting new biological approaches to therapy are being investigated. Most new treatment regimens involve adding new therapies (such as peripheral blood stem-cell support) to existing chemotherapy [2]. However, drugs for efficient treatment of osteosarcoma are still being sought.…”

Peripheral blood stem cell mobilization by granulocyte colony-stimulating factor alone and engraftment kinetics following autologous transplantation in children and adolescents with solid tumor

“…Autologous hematopoietic stem cell transplantation is increasingly performed for the treatment of various pediatric and adolescent cancers, 1,2 and currently most centers use peripheral blood stem cells (PBSC) as the source of stem cells to support high-dose chemotherapy. The advantages of PBSC include rapid hematopoietic recovery following transplantation, and less of a potential for tumor cell contamination of the grafts.…”

High-dose chemotherapy and autologous stem cell transplantation with melphalan, etoposide and carboplatin for high-risk osteosarcoma

“…9,10 Although methotrexate, doxorubicin, cisplatin and ifosfamide were shown to be active agents in osteosarcoma, their uses in high doses are limited owing to their toxicities. 11 However, high doses of etoposide and carboplatin have been shown to have antitumor effect with suitable toxicity profiles.…”