Role of Neo-Adjuvant Chemotherapy in the Treatment of Osteosarcoma

Ranadeb Bandyopadhyay, Arindam Mukherjee, Bishan Basu

Department of Orthopaedics, Bankura Sammilani Medical College, Bankura, India.
Department of Radiotherapy, Bankura Sammilani Medical College, Bankura, India.

DOI: 10.4236/ojo.2012.22005                

Abstract

Osteosarcoma is a tumour characterized by the production of osteoid by malignant cells. The incidence is approximately 1 to 3 million/year. The incidence is slightly higher in males. Onset can occur at any age; however, primary high grade osteosarcoma usually occurs in the second decade of life. Historically patients with osteosarcoma were treated with immediate wide or radical amputation. Despite the treatment, 80% patients with apparently isolated disease died of distant metastases. In recent years the number of patients with osteosarcoma of the limb treated by amputation + chemotherapy has increased. In our study, we divided the patients into two groups. One group (A) was treated with amputation + adjuvant chemotherapy. The other group (B) was treated with neo-adjuvant chemotherapy + amputation followed by adjuvant-chemotherapy. In our study, the margin negativity in post surgical specimen was significantly higher (P-value 0.0007) for the group treated with neo-adjuvant chemotherapy. Local recurrence in the group treated without neoadjuvant chemotherapy was significantly more (P-value 0.0005).The systemic recurrence at the end of 6 months was higher the group treated without neoadjuvant chemotherapy (P-value 0.0169).However systemic recurrence between 6 months -1 year and 1 year - 2 years were not significant(P-values 0.1501 and 0.4902). From the above figures it may be concluded that treatment with neo-adjuvant chemotherapy + amputation + adjuvant chemotherapy had definite advantages over upfront amputation + adjuvant chemotherapy.)

Keywords

Osteosarcoma; Amputation; Neo-Adjuvant Chemotherapy; Adjuvant Chemotherapy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	R. K. Heck, “Malignant Tumours of Bone: Campbell’s Operative Orthopaedics,” 11th Edition, Mosby Elsevier, Philadelphia, 2010, pp. 901-904.
[2]	R. L. Souhami, A. W. Craft, J. W. Van der Eijken, M. Nooij, et al., “Randomised Trial of Two Regimens of Chemotherapy in Operable Osteosarcoma: A Study of the European Osteo-sarcoma Intergroup,” Lancet, Vol. 350, No. 9082, 1997, pp. 911-917. doi:10.1016/S0140-6736(97)02307-6
[3]	M. Natarajan , M. Paraskumar, G. Rajkumar, A. Sivaseelam and S. Na-tarajan, “Limb Salvage in Aggressive and Malignant Tumours in the Fibula,” International Orthopaedics, Vol. 28, No. 5, 2004, pp. 307-310. doi:10.1007/s00264-004-0566-x
[4]	M. Hegyi, A. F. Semsei, Z. Jakob, M. Szendrol, M. Csoka and G. Kovacs, “Good Prognosis of Localised Osteosarcoma in Young Patients Treated with Limb Salvage Surgery and Chemotherapy,” Pediatric Blood Cancer, Vol. 57, No. 3, 2011, pp. 415-422. doi:10.1002/pbc.23172
[5]	W. S. Song, D. G. Jeon, C. B. Kong, W. H. Cho and S. Y. Lee, “Outcome of Re-Excision of Intralesionally Treated Parosteal Osteosarcoma,” Journal of Surgical Oncology, Vol. 103, No. 3, 2011, pp. 264-268. doi:10.1002/jso.21822
[6]	W. Guo, X. Sin and T. Ji, “Evaluation of Surgical Treatment of Pelvic Osteosarcoma,” Zhonghua Wai Ke Za Zhi, Vol. 48, No. 13, 2010, pp. 994-998.
[7]	M. A. Ayerza, G. L. Farfalli, L. Aponti-Tinao and D. L. Musculo, “Does Increased Rate of Limb Sparing Surgery Affect Survival in Osteosarcoma?” Clinical Orthopaedics and Related Research, Vol. 468, No. 11, 2010, pp. 2854-2859. doi:10.1007/s11999-010-1423-4
[8]	P. Ruggieri, T. Calabro, M. Montalti and M. Mercuri, “The Role of Surgery and Adjuvants to Survival in Pagetic Osteosarcoma,” Clinical Orthopaedics and Related Research, Vol. 468, No. 11, 2010, pp. 2962-2968. doi:10.1007/s11999-010-1473-7
[9]	S. Ferrari, E. Palmerini, E. L. Staals, M. Mercuri, B. Franco, P. Picci and G. Bacci, “The Treatment of Non-Metastatic High Grade Osteosarcoma of the Extremity: Review of the Italian Rizzoli Experience. Impact on Future,” Cancer Treatment and Research, Vol. 152, No. 3, 2009, pp. 275-287.
[10]	H. J. Kim, P. M. Chalmers and C. D. Morris, “Pediatric Osteogenic Sarcoma,” Current Opinion in Pediatrics, Vol. 22, No. 1, 2010, pp. 61-66. doi:10.1097/MOP.0b013e328334581f
[11]	A. Daigeler, M. Lehnhardt, A. Khadra, J. Hauser, L. Steinstrasses, S. Langer, O. Goertz and H. U. Steinau, “Proximal Major Limb Amputations: A Retrospective Analysis of 45 Oncological Cases,” World Journal of Surgical Oncology, Vol. 7, No. 1, 2009, pp. 7-15.
[12]	A. Longhi, C. Errani, D. Gonzales-Arabio, C. Ferrari and M. Mercuri, “Os-teosarcoma in Patients Older than 65 Years,” Journal of Clinical Oncology, Vol. 26, No. 33, 2008, pp. 5368-5373. doi:10.1200/JCO.2007.14.9104
[13]	R. Lumbreras, A. Castro, S. Val, F. J. Modrego and M. L. Bello, “Salvage Surgery Treatment in Osteosarcoma of the Fibula with Seventeen Years Survival,” Revista de la Facultad de Ciencias Médicas de la Universidad Nacional de Córdoba, Vol. 64, No. 1, 2007, pp. 38-41.
[14]	G. Bacci, S. Ferrari, M. Mercuri, et al., “Neoadjuvant Chemotherapy for Extremity Osteosarcoma: Preliminary Results of the Rizzoli’s 4th Study,” Acta Oncology, Vol. 37, No. 1, 1998, pp. 41-48.
[15]	N. Delepine, G. Delepine, S. Alkallaf, et al., “Local Relapses Following Limb Sparing Salvage Surgery for Osteosarcoma: Prognostic Factors and Influence of Chemotherapy,” American Society of Clinical Oncology Proceedings, Vol. 15, Philadelphia, 1996, p. 526.
[16]	G. Saeter, T. Wiebe, T. Wiklund, et al., “Chemotherapy in Osteosarcoma: The Scandinavian Sarcoma Group Experience,” Acta Orthopaedica Scandinavica Supplementum, Vol. 285, No. 70, 1999, pp. 74-82.
[17]	U. Nilsonne, L. A. Brostrom and T. Aparisi, “Local Tumor Resection in Interferon Treated Osteosarcoma Patients,” Annales Chirurgiae et Gynaecologiae, Vol. 84, No. 1, 1995, pp. 63-70.
[18]	S. S. Bielack, B. Kempf-Bielack and K. Winkler, “Osteosarcoma: Rela-tionship of Response to Preoperative Chemotherapy and Type of Surgery to Local Recurrence,” Journal of Clinical Oncology, Vol. 14, No. 10, 1996, pp. 683-684.
[19]	O. Brosjo, “Surgical Procedure and Local Recurrence in 223 Patients Treated 1982 -1997 according to Two Osteosarcoma Chemotherapy Protocols: The Scandinavian Sarcoma Group Experience,” Acta Orthopaedica Scandinavica Supplementum, Vol. 285, No. 70, 1999, pp. 58- 61.
[20]	N. J. Lindner, O. Ramm, A. Hillmann, et al., “Limb Salvage and Outcome of Osteosarcoma: The University of Muenster Experience,” Clinical Orthopaedics, Vol. 358, 1999, pp. 83-89.
[21]	http://www.graphpad.com/quickcalcs