Treatment of nonmetastatic osteosarcoma of the extremity with preoperative and postoperative chemotherapy: a report from the Children's Cancer Group.

Provisor, Arthur J.; Ettinger, Lawrence J.; Nachman, James B.; Krailo, Mark; Makley, John T.; Yunis, Eduardo J.; Huvos, Andrew G.; Betcher, Donna L.; Baum, Edward S.; Kisker, C. Thomas; Miser, James S.

doi:10.1200/jco.1997.15.1.76

Cited by 431 publications

(300 citation statements)

References 11 publications

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“…The theory that good histologic response correlates with improved prognosis has been supported in the literature [9,42]. The use of serial arteriography in our study had a 92.5% rate of accuracy and 100% sensitivity in predicting good tumor response (greater than 90%).…”

Section: Discussionsupporting

confidence: 69%

“…Only serial arteriography as used in this study accurately predicted tumor necrosis [13]. Tumor necrosis is reportedly one of the most important prognostic factors impacting long-term survival in nonmetastatic osteosarcoma [9,15,42]. By using serial arteriography to monitor tumor response and individualize the duration of neoadjuvant therapy, we achieved a 77% rate of good histologic response.…”

Section: Discussionmentioning

confidence: 86%

“…By using serial arteriography to monitor tumor response and individualize the duration of neoadjuvant therapy, we achieved a 77% rate of good histologic response. We deduce that our high rate of good response likely translated into an exceptional survival rate as opposed to more traditional protocols which prescribe a set number of preoperative cycles and result in survival rates in the 70% range [1,3,4,7,19,21,24,[42][43][44]52].…”

Section: Discussionmentioning

confidence: 99%

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Intraarterial Chemotherapy for Extremity Osteosarcoma and MFH in Adults

Hugate

Wilkins

Kelly

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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The neoadjuvant treatment of osteosarcoma using intravenous agents has resulted in survival rates of 55% to 77% [3,5,6,20,22,35]. We designed a neoadjuvant chemotherapy protocol using combined intraarterial and intravenous agents to treat high-grade osteosarcoma and malignant fibrous histiocytoma of bone in an attempt to improve survival. We report the results of treating 53 adults (age 18-77 years) diagnosed with nonmetastatic extremity osteosarcoma or malignant fibrous histiocytoma. Preoperative chemotherapy consisted of intravenous doxorubicin followed by intraarterial cisplatinum administered repetitively every 3 weeks for three to five cycles, depending on tumor response assessed by serial arteriography. Dose and duration of cisplatin were adjusted for tumor size. After resection, good responders (90% or greater necrosis) underwent treatment with the same agents and poor responders were treated with alternative agents for longer duration. Minimum followup was 24 months (mean, 111 months; range, 24-235 months). Estimated Kaplan-Meier survival at 10 years was 82% and event-free survival was 79%. Forty-one patients (77%) had a good histologic response and 92% (49 of 53) underwent limbsparing procedures. Local recurrence occurred in two patients (4%). These results compared favorably with those reported in the current literature.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Intraarterial Chemotherapy for Extremity Osteosarcoma and MFH in Adults

Hugate

Wilkins

Kelly

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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“…With the introduction of modern treatment protocols involving aggressive surgery and neoadjuvant chemotherapy, 5-year survival rates of 50-60% are common for patients presenting without metastatic disease. [1][2][3][4] However, 40-50% of patients will develop metastases and few of them will be cured. A more thorough understanding of the molecular events underlying osteosarcoma development and metastasis has the potential to lead to further advances in patient management and improved outcomes.…”

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confidence: 99%

von Willebrand factor expression in osteosarcoma metastasis

et al. 2005

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A number of genes are implicated in the initiation and progression of osteosarcoma; however, cytogenetic and comparative genomic hybridization studies indicate the involvement of additional unidentified genes. An examination of gene expression profiles in 22 high-grade osteosarcoma tumor specimens from 15 patients (including paired primary and metastatic samples from five patients) indicated that von Willebrand factor (vWF) mRNA expression may increase during tumor progression. vWF, a large glycoprotein previously considered to be expressed exclusively by endothelial cells and megakaryocytes, is involved in platelet aggregation and adhesion to the subendothelial matrix, processes critical to hematogenous tumor cell metastasis to the lung. Analysis of paired primary and metastatic osteosarcoma tumor samples from 10 patients revealed an increase in vWF gene expression in metastases (P ¼ 0.005). Immunohistochemistry showed that, in addition to the endothelial cells, vWF protein was also detected in osteosarcoma cells in vivo in 13 of 29 tumor specimens as well as in SAOS2, an osteosarcoma cell line. The tumor cell staining correlated positively with high vWF expression in the sample (P ¼ 0.006). Although vascular endothelial cells contribute to the vWF mRNA detected in the tumor samples, there was neither any correlation between vascular density (VD) and vWF mRNA expression nor between VD and clinical outcome. These findings suggest that vWF expression is deregulated in osteosarcoma tumors, potentially contributing to metastasis.

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“…The identification of effective chemotherapy significantly improved the outcome with long-term relapse free survival rates ranging from 55 to 75% over the last several decades. 1,2 On the other hand, the remainder of patients will relapse most often with pulmonary metastases. These patients poorly respond to chemotherapy.…”

mentioning

confidence: 99%