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lüll Intraarterial chemotherapy for extremity osteosarcoma and MFH in adults Hugate RR; Wilkins RM; Kelly CM; Madsen W; Hinshaw I; Camozzi ABClin Orthop Relat Res 2008[Jun]; 466 (6): 1292-301The neoadjuvant treatment of osteosarcoma using intravenous agents has resulted in survival rates of 55% to 77% [3, 5, 6, 20, 22, 35]. We designed a neoadjuvant chemotherapy protocol using combined intraarterial and intravenous agents to treat high-grade osteosarcoma and malignant fibrous histiocytoma of bone in an attempt to improve survival. We report the results of treating 53 adults (age 18-77 years) diagnosed with nonmetastatic extremity osteosarcoma or malignant fibrous histiocytoma. Preoperative chemotherapy consisted of intravenous doxorubicin followed by intraarterial cisplatinum administered repetitively every 3 weeks for three to five cycles, depending on tumor response assessed by serial arteriography. Dose and duration of cisplatin were adjusted for tumor size. After resection, good responders (90% or greater necrosis) underwent treatment with the same agents and poor responders were treated with alternative agents for longer duration. Minimum followup was 24 months (mean, 111 months; range, 24-235 months). Estimated Kaplan-Meier survival at 10 years was 82% and event-free survival was 79%. Forty-one patients (77%) had a good histologic response and 92% (49 of 53) underwent limb-sparing procedures. Local recurrence occurred in two patients (4%). These results compared favorably with those reported in the current literature. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.|Adolescent[MESH]|Adult[MESH]|Aged[MESH]|Antineoplastic Agents/*administration & dosage[MESH]|Arm Bones[MESH]|Bone Neoplasms/complications/diagnostic imaging/*drug therapy[MESH]|Cisplatin/*administration & dosage[MESH]|Cohort Studies[MESH]|Dose-Response Relationship, Drug[MESH]|Doxorubicin/*administration & dosage[MESH]|Drug Administration Schedule[MESH]|Female[MESH]|Histiocytoma, Malignant Fibrous/complications/diagnostic imaging/*drug therapy[MESH]|Humans[MESH]|Infusions, Intra-Arterial[MESH]|Infusions, Intravenous[MESH]|Leg Bones[MESH]|Male[MESH]|Middle Aged[MESH]|Neoadjuvant Therapy[MESH]|Osteosarcoma/complications/diagnostic imaging/*drug therapy[MESH]|Radiography[MESH] |