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

作者：Gerald Paul Rosen, Brenda Caparros, Andrew G. Huvos, Cynthia Kosloff, Anita Nirenberg, Adrienne Cacavio, Ralph C. Marcove, Joseph M. Lane, Bipin M. Mehta, Christian Urban · 发表于：Cancer · 年份：1982 · DOI：10.1002/1097-0142(19820315)49:6<1221::aid-cncr2820490625>3.0.co;2-e · 被引用次数：1104 · 研究领域：Sarcoma Diagnosis and Treatment、Vascular Tumors and Angiosarcomas、Lymphoma Diagnosis and Treatment

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. All 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, HDMTX 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 in 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 ...