The Value of Serial Arteriography in Osteosarcoma: Delivery of Chemotherapy, Determination of Therapy Duration, and Prediction of Necrosis
Section snippets
Study Design
This was a prospective, institutional review board–approved, single-arm study of newly diagnosed high-grade osteosarcoma and MFH of bone. All arteriography procedures and IA infusions were performed at a single institution (Presbyterian/St. Luke's Medical Center, Denver, CO).
To be eligible, patients were required to have biopsy-proven newly diagnosed high-grade osteosarcoma or MFH of bone. In the majority of cases, adequate biopsy tissue was obtained via core needle technique. If this sample
RESULTS
A total of 109 patients underwent 408 arteriography procedures followed by an IA infusion of cisplatin. Two hundred seventy treatments were infused over 6-hour periods and 138 were infused over 24-hour periods. Forty-two patients received the minimum three cycles, 53 required four, and 14 received five neoadjuvant cycles. Tumor neovascularity was decreased by at least 90% in 88%, 89%, and 71% of patients who received three, four, and five cycles, respectively. Fifteen patients did not exhibit a
DISCUSSION
The histologic response to neoadjuvant therapy is one of the most important prognostic factors for long-term survival in nonmetastatic osteosarcoma (11). In a multivariate analysis of 1,702 patients, Bielack et al (12) found that histologic response was the most important prognostic factor for osteosarcoma of the extremity (P <.0001). Provisor et al (13) reported 8 year event-free survival and overall survival rates of 81% and 87%, respectively, for cases with good response, versus 46% and 52%,
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Tumors and Related Conditions
2016, Rockwood and Matsen’s The ShoulderChemotherapeutic adjuvant treatment for osteosarcoma: Where do we stand?
2011, European Journal of CancerCitation Excerpt :Because in many studies histological response has been an highly important prognostic factor, intensifying pre-operative chemotherapy not only increases the response rate,104,105,107,118 but also leads to better survival in most studies.105,111,130 Although getting a higher intratumoural drug concentration by intra-arterial infusions in possible, resulting in a high fraction of tumour cell necrosis,69,78,106,115,131–133 this route of administration does not result in a better survival than when given intravenously.78,105,106,115,134 Therefore, intensifying chemotherapy beyond a certain level does not improve outcome, neither for pGR nor for salvage pPR.89,95,113,114,118,121
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2011, Techniques in Vascular and Interventional RadiologyCitation Excerpt :In a large study conducted by Cullen et al, 408 IA infusions of cisplatin in 109 patients with osteosarcoma were analyzed and only 3 minor complications were reported, including painful arterial spasm managed with medication and local hematoma, which resolved after applying local pressure.20 Also, Cullen et al reported 7 cases of deep vein thrombosis in the infused extremity within 10 days of therapy.20 However, it is uncertain whether the complications were related to the procedure.20
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From the 2004 SIR Annual Meeting.
None of the authors have identified a conflict of interest.