RESUMEN
Multidisciplinary treatment of osteosarcoma in the Faculty of Medicine Ramathibodi Hospital, Mahidol University, using preoperative intraarterial and postoperative chemotherapy, with or without local irradiation, combined with surgery and prophylactic lung irradiation provided an excellent 5 years' survival of 55 per cent, the same rate as the 9 years' survival. The survival was stable after 4.4 years. The patients with local irradiation had more tumor destruction apparent on the surgical specimen. The administration of prophylactic whole lung irradiation provided an outcome without any undesirable complication. Sixteen per cent of the cases with PLI developed lung metastasis compared to 48 per cent without PLI. The most important prognostic factor was low level of serum lactic acid dehydrogenase. The unanswered question is what is the optimal treatment for osteosarcoma?
Asunto(s)
Neoplasias Óseas/terapia , Osteosarcoma/terapia , Neoplasias Óseas/mortalidad , Terapia Combinada , Humanos , Tablas de Vida , Osteosarcoma/mortalidad , Tasa de SupervivenciaRESUMEN
One hundred thirty patients with high grade osteosarcoma were enrolled in a randomized prospective multidisciplinary treatment that included intraarterial chemotherapy, local irradiation, limb salvage surgery, and prophylactic whole lung irradiation. The patients were evaluated to stage the prognostic factors. In a multivariate analysis, a minimal level of serum lactic acid dehydrogenase less than 300 IU/L showed a significant prognostic value. The history of trauma before diagnosis of disease, local irradiation of the affected site, histologic response to preoperative multidisciplinary therapy, and prophylactic whole lung irradiation were associated with significantly better prognosis in the log rank test. Patient age, site of the primary tumor, presentation of fracture, pathologic subtype, signs and symptoms, serum alkaline phosphatase level, and erythrocyte sedimentation rate were not found to be prognostic factors. The 9-year survival rate of the whole group was 55%.
Asunto(s)
Neoplasias Óseas/cirugía , Osteosarcoma/cirugía , Adolescente , Adulto , Factores de Edad , Fosfatasa Alcalina/sangre , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Sedimentación Sanguínea , Neoplasias Óseas/tratamiento farmacológico , Neoplasias Óseas/patología , Neoplasias Óseas/radioterapia , Huesos/lesiones , Huesos/efectos de la radiación , Niño , Terapia Combinada , Femenino , Fracturas Óseas/etiología , Fracturas Óseas/patología , Humanos , Inyecciones Intraarteriales , L-Lactato Deshidrogenasa/sangre , Modelos Lineales , Pulmón/efectos de la radiación , Neoplasias Pulmonares/prevención & control , Neoplasias Pulmonares/secundario , Masculino , Análisis Multivariante , Estadificación de Neoplasias , Osteosarcoma/tratamiento farmacológico , Osteosarcoma/patología , Osteosarcoma/radioterapia , Osteosarcoma/secundario , Pronóstico , Estudios Prospectivos , Tasa de SupervivenciaRESUMEN
Intraarterial plus systemic chemotherapy of cis-diamine dichloroplatinum-II and anthracycline together with preoperative radiation and "limb salvage" treatment have increased the chance of local control and facilitated the previous surgically nonresectable to be resectable. Among 30 cases of osteosarcoma from 1986-1989, aged 9-43 years old, 10 of the 17 cases (58.8%) are still alive with the mean disease free survival of 27.8 months. Late pulmonary metastases cause the need for future protocol for prophylactic lung therapy.
