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[Combined multimodal therapy for osteosarcoma--neoadjuvant chemotherapy]
T Hirota1, K Konno, T Fujimoto
1Department of Pediatrics, Aichi Medical University, Japan.
Gan to Kagaku Ryoho. Cancer & Chemotherapy
|August 4, 1999
Summary
Osteosarcoma survival rates have significantly improved due to combination chemotherapy and limb-sparing surgery. However, effective systemic treatments for pulmonary metastases remain a critical need for better patient outcomes.
Area of Science:
- Orthopedic Oncology
- Medical Oncology
- Surgical Oncology
Context:
- Osteosarcoma survival rates improved from <20% to 60-70% by the 1990s.
- Limb-sparing surgery replaced amputation in many cases.
- Neoadjuvant chemotherapy is standard, utilizing agents like methotrexate (MTX), doxorubicin (ADR), bleomycin/cyclophosphamide/dactinomycin (BCD), and cisplatin (CDDP).
Purpose:
- To critically review current osteosarcoma management.
- To propose a treatment strategy for discussion.
- To highlight the need for improved systemic therapies for metastatic osteosarcoma.
Summary:
- Histologic response to neoadjuvant chemotherapy is the most crucial prognostic factor.
- Pulmonary metastases are the leading cause of death, with a 30% actuarial survival rate despite salvage therapy.
- Newer agents like ifosfamide (IFM) and etoposide (ETP) are being integrated into treatment regimens.
Impact:
- Improved survival rates and limb preservation in osteosarcoma patients.
- Identification of key prognostic factors, emphasizing chemotherapy response.
- Highlights the urgent need for novel systemic treatments to improve outcomes for patients with pulmonary metastases.