Chemotherapy, en bloc resection, and prosthetic bone replacement in the treatment of osteogenic sarcoma

Gerrand, CH; Rankin, K

doi:10.1007/978-1-4471-5451-8_124

Chemotherapy, en bloc resection, and prosthetic bone replacement in the treatment of osteogenic sarcoma

Lookup NU author(s): Craig Gerrand, Dr Kenneth Rankin ORCiD

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Abstract

© 2014 Springer-Verlag London. All rights are reserved. Background In order to facilitate complete surgical removal of biopsy proven osteogenic sarcoma from the lower limb of 20 patients (15 distal femur and 5 proximal tibia) without resorting to amputation, chemotherapy was administered preoperatively to shrink the tumours. Methods The intensive chemotherapy regime consisted of high dose methotrexate (HDMTX) with citrovorum factor rescue (CFR) and adriamycin (ADR) followed by en bloc resection of the primary tumour with prosthetic replacement of the involved bone. After surgery, adjuvant chemotherapy, consisting of HDMTX with CFR, ADR, and high dose cyclophosphamide was given sequentially for 1 year. Results 18 of 20 patients (two with evidence of pulmonary metastases) had primary tumours that could be clinically measured. In 17 cases the size of the primary tumour decreased prior to surgery. To date, 12 of these patients with tumours of the distal femur have had total femur and knee joint replacement, and 3 patients with tumours of the proximal tibia have had total knee replacement. In all 15 patients, surgical margins were grossly and microscopically free of tumour and at follow up of 2-15 months there has been no evidence of soft tissue recurrence. Conclusions These preliminary results indicate that with the use of aggressive chemotherapy, it is possible to demonstrate objective tumour regression in primary osteogenic sarcoma, allowing the surgeon to perform en bloc resection of tumour and prosthetic replacement of the involved bone. This facilitates preservation of the limb but it is important to stress that extensive surgery yielding tumour-free margins is performed. The ultimate evaluation of this approach to the treatment of primary osteogenic sarcoma will require longer observation, to determine limb function and continued disease-free status, once adjuvant chemotherapy is discontinued.