Weekly high-dose methotrexate and doxorubicin for osteosarcoma: the Dana-Farber Cancer Institute/the Children's Hospital--study III.

Abstract

Weekly high-dose methotrexate with leucovorin rescue and vincristine (HDMTX) and doxorubicin was administered as adjuvant postoperative therapy to 46 patients with a diagnosis of conventional high-grade nonmetastatic osteosarcoma of an extremity between July 1976 and December 1981. The primary lesions were managed by wide or radical amputation (26 patients) or by limb-sparing resection in 20 selected patients. The margins of the resections were retrospectively classified as marginal in three, wide in 16, and radical in one. The 5-year relapse-free survival (RFS) for all patients is 59% (95% confidence interval [CI], 43%, 74%) and overall survival is 78% (95% CI, 65%, 91%). The RFS for patients initially having a limb resection procedure is 55% (95% CI, 32%, 77%) compared with 62% (95% CI, 43%, 81%) for those initially having amputations (P = .52). Using multivariate analysis, the only significant prognostic variables that predicted RFS of greater than or equal to 3 years, were the presence of moderate to marked lymphocytic infiltration of the primary tumor (P less than .002), primary site outside of the proximal humerus (P less than .005), and the absence of a predominance of osteoblastic pattern in the primary tumor (P less than .03).

Outcome of flat bone sarcomas (other than Ewing's) in children and adolescents: a study of 25 cases

“…With the exception of Ewing's sarcoma, other primary flat bone sarcomas (osteosarcoma, malignant fibrous histiocytoma and chondrosarcoma) are rare in children and adolescents, and their incidence increases with advancing age (Boland and Huvos, 1986;Goorin et al, 1987;Huvos and Marcove, 1987;Tucker et al, 1987;Young et al, 1990). In contrast, bone sarcoma occurring as a second malignant neoplasm after irradiation is more likely to arise in flat bones of the axial skeleton than are de novo bone sarcomas (Weatherby et al, 1981;Huvos et al, 1985;Stea et al, 1987;Pratt et al, 1997;Tabone et al, 1999).…”

High Dose Methotrexate and Leucovorin Rescue Therapy in Childhood Malignancies: Experience in Resource-Limited Country

“…The highest dose, 33.6 g/m 2 , has been without intrathecal instillation. 14 In various disease doses of MTX varies, for pediatric osteosarcoma doses of 12 gm/m2/ of MTX followed by leucovorin 15,16 then surgery follows with doxorubicin and cisplatin. ALL has dose ranges from 1-8 g per m 2 .…”

Chemotherapy in Osteosarcoma

“…Cytotoxic lymphocytes are present in such patients 60,61 , and in at least one study, the degree of lymphocytic infiltration correlated with survival 61 . These findings have prompted investigators to explore a variety of immunotherapeutic approaches for patients with advanced osteosarcoma.…”