Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0029463 (osteosarcoma)
 16,637 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ten years' results of 56 patients with high grade osteogenic sarcoma are reported. Fifty-two patients had M0 disease. Immediately after open biopsy the patients were treated with chemotherapy using modified Rosen's protocols T4, T7 and T10. The primary tumor was adequately removed in most patients. Six children were treated with limb saving. The actuarial and disease-free survival was 80% after 1 year, and 73% to 8 years. Two patients died because of toxic side effects of chemotherapy, one of septicemia, the other of late cardiac failure secondary to doxorubicin.
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PMID:Ten years' experience in patients with osteogenic sarcoma in Finland. 169 Nov 10

Between April and September 1986, 60 patients with osteosarcoma have been treated according to the T10 protocol in the Pediatrics Department of the Gustave Roussy Institute in Villejuif, France. Limb sparing could be achieved in 49 patients and amputation was necessary in 11. The necrosis of the primary tumor was total or subtotal in 33 cases and incomplete in the 27 others. With a median follow-up of 28 months, the actuarial survival is 85% at 48 months and the actuarial disease-free survival is 58%; the disease-free survival of "good responders" is 75% and 32% for "bad responders".
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PMID:[Experience with protocol T10 in the pediatric service at the Gustave-Roussy Institute]. 245 56

The authors evaluated a new protocol of neoadjuvant chemotherapy for osteosarcoma, easier to manage and different from T10. The good results obtained with the postoperative ADR-CDDP association led us to undertake a pilot study between 1982 and 1984, using ADR-CDDP as preoperative chemotherapy. The records of sixteen patients were available for follow-up. The average age of the patients was 19.9 years. Patients received two or three preoperative courses, and a total of six identical courses. Tolerance was good. Pain usually disappeared but this was often misleading because associated with radiological and/or clinical tumor progression, low histological necrosis or poor outcome. The continuous disease-free survival actuarial rate was less than 57 and 40% at 18 months and two years respectively. The actuarial survival rate was 87% at one year and 65% at two years respectively. Disappointing results of this preoperative protocol, compared to results with the SO4 78 or T10 protocols for example, led to publish these data early in order to underline their potential dangers. As a result, we stopped our study. The charter of pilot studies justifies this publication. As well, these data point out the necessity of very close follow-up of neoadjuvant chemotherapy by sophisticated medical imaging. Neoadjuvant chemotherapy, if ineffective, must be stopped early, and should lead to surgery, followed by adequate postoperative chemotherapy.
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PMID:[Pre and postoperative chemotherapy of osteosarcoma with an adriamycin-cisplatin combination. Risks of a neoadjuvant chemotherapy which is not sufficiently effective]. 346 71

Functional results and survival have been improved in osteosarcoma during the last ten years, thanks to better conservative surgical techniques and more efficient drugs to prevent metastases. Of the several possible programmes of chemotherapy, the authors considered that the T10 programme of Rosen is the most reliable, this author claiming a survival rate of 90 p. 100 with an average follow-up of twenty months. This programme was adopted by the authors in the Paediatric Department of the Gustave Roussy Institute (Villejuif). Thirty one patients were treated and assessed after an average follow-up of 19 months. The results were favourable, only three patients presenting with metastases. One died. Amongst the thirty surviving patients, twenty-three were treated by local resection and eight by amputation.
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PMID:[Chemotherapy of osteogenic sarcoma]. 391 12

15 consecutive patients with osteosarcoma underwent preoperative chemotherapy with high dose methotrexate (HDMTX) containing regimens according to the T7 or T10 protocols of ROSEN, Preoperative chemotherapy was well tolerated and did not impair surgical procedures. 67% of the patients responded clinically with reduction of pain and tumor size. Histologic examination of the tumor after preoperative chemotherapy revealed extensive necrosis in 53% of patients. In a retrospective analysis, patients with extensive necrosis (group B) were compared with those with little or no necrosis (group A). Patients from group B had a longer relapse free and overall survival period than group A. In addition, patients of group A had significantly higher initial levels of alkaline phosphatase than group B. The incidence of a 2.5-fold increase of the transaminases 2-3 days after HDMTX was significantly greater in patients of group B compared to group A. In the absence of documented necrosis after chemotherapy according to the T7 or T10 protocols, further use of HDMTX is not indicated. New aspects on the treatment of osteosarcoma, derived from recent publications, are discussed.
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PMID:[The Zurich experience with preoperative high-dose methotrexate in osteosarcomas]. 657 41

This paper evaluates the influence of pharmacokinetics monitoring of HDMTX in the treatment of localized operable previously untreated high grade osteosarcoma. 44 patients (group 1) received a T10 protocol with dose adapted only to age. 27 other patients (group 2) had a pharmacokinetics monitored dose adaptation of MTX. The pharmacokinetics monitoring leads to higher dosage, higher area under the concentration/time curve and permits higher toxicity to be avoided. The higher dose intensity of MTX gave higher histologic response rate (66% compared to 45%) and higher 5 year disease free survival (92% compare to 76%). HDMTX treatment of osteosarcoma should be dose adapted to indivi-dual pharmacokinetics.
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PMID:Dose escalation with pharmacokinetics monitoring in methotrexate chemotherapy of osteosarcoma. 776 28

Original articles published between 1991-1996 were selected according to specified criteria, and reviewed to provide answers to nine important questions about the role of chemotherapy in the management of non-metastatic extremity osteosarcoma: (1) Does adjuvant chemotherapy improve survival? (2) Are the results of the Rosen T10 protocol reproducible in different settings? (3) Is chemotherapy with two of the most active drugs (DOX/DDP) an effective adjuvant treatment, and comparable to other multiagent regimens? (4) Does histological response to neoadjuvant chemotherapy correlate with reduced local recurrence and/or improved survival? (5) Does a change of chemotherapy for patients whose tumors show a poor histological response to chemotherapy improve survival? (6) Does chemotherapy given before surgery (neoadjuvant) improve survival? (7) Are certain drugs, or their method of administration (route, duration, total dose, dose intensity, pharmacokinetics) important in determining outcomes? (8) Can new agents such as Ifosfamide be incorporated into intensive multi-agent chemotherapy, and does this improve pathological response and/or survival? (9) Can dose intensity of treatment be increased with G-CSF? The brief answers to questions 1-3 and 7-9 are "Yes"; question 4 "Yes, but may be changing"; and questions 5, 6 "Not proven," and these are expanded in the text. Future directions for treatment of osteosarcoma are covered under the headings identification of new agents, dose intensification, circumvention of drug resistance, immunotherapy, and insulin-like growth factor.
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PMID:The role of chemotherapy in the management of non-metastatic operable extremity osteosarcoma. 934 23

Between 1989 and 1996, 21 skeletally immature patients were treated for osteosarcoma of the extremity. Their average age was 12.6 years (range 9-16 years). We classified the location and extent of the lesion in bone on magnetic resonance imaging (MRI) with reference to the growth plate and joint margin into five subtypes. This classification served as a guide for the level of resection and the type of reconstruction required for a limb salvage procedure. All patients received neoadjuvant chemotherapy using a modified T10 protocol before the definitive operation. These patients were followed up for periods ranging from 11-86 months, with a mean of 35. 5 months. Patients were assessed for (1) local tumour recurrence, (2) metastatic disease, (3) allograft complications and (4) extremity function and joint stability. Excellent function was retained in 2, good in 13 and fair function in 6 patients. The MRI classification proved useful for the resection and provides an insight into the possible functional outcomes.
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PMID:Classifying the location of osteosarcoma with reference to the epiphyseal plate helps determine the optimal skeletal resection in limb salvage procedures. 1044 33

We report the results of a prospective Tunisian study using primary chemotherapy followed by conservative surgery in primitive limb osteosarcoma. From January 1988 to January 1998, 56 patients affected by limb osteosarcoma entered in a prospective study of neoadjuvant chemotherapy with the T10 protocol before surgery with a conservative intent. Initial work-up include: clinical exam with tumor measurements, chest and limb X-rays, limb CT-scan or MRI, chest CT-scan, bone scintigraphy and hematological and renal biological exams. Patients receive pre- and post-operative chemotherapy according to the T10 modified protocol. Fifty-six patients (33 M/23 F) with a mean age of 19 years (8 to 28) are included. Mean clinical and radiological tumor size is around 14 cm. Main histologic type is classic osteosarcoma (50% of cases) and 10 patients (9%) presented with initial metastasis; 42 patients on 56 receive the whole pre-operative protocol. Treatment is well tolerated excluding 18 episodes of mucositis, 29 of leucopenia (< grade 3), 7 of thrombopenia (< grade 3), 4 of cutaneous toxicity, 2 of pulmonary toxicity and 3 of nausea-vomiting. We observe 36% of good histological responders and 64% of bad responders to primary chemotherapy, 27 patients on 49 operated (53%) have a conservative surgery and 18 (47%) a radical surgery. With a median follow-up of 51 months (8 to 128), 29 patients remain alive free of disease (15/17 GR and 14/30 BR), 2 are alive with disease, 2 died by toxicity, 14 died by progressive disease and 9 are lost to follow-up with evolutive disease. Five year disease-free survival is 55% for the 46 non metastatic patients. In univariate analysis, seric alkaline phosphatase level (p = 0.0014) and histological response to chemotherapy (p = 0.0218) are significant factors for prognosis.
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PMID:[Primary chemotherapy with the Rosen T10 protocol before conservative surgery in limb primitive osteosarcomas: results about 56 cases]. 1070 89

In the late 1970s, there was confusion regarding the best management for osteosarcoma. The benefit of chemotherapy had not been established and which chemotherapy could be used was even more uncertain. The European Osteosarcoma Intergroup (EOI) was established in order to conduct randomised studies to determine the best treatment for this tumour. Their first study 80831 established that a two drug combination of CDDP/DOX was safe and improved the survival rate over previous regimes with suboptimal chemotherapy. The CDDP/DOX was superior to a less intense CDDP/DOX/MTX regime. The second study 80861 compared the CDDP/DOX arm with a multi-drug Rosen-T10 regime. In almost 400 patients, there was the difference in outcome between the two arms. However, adherence to the protocol and completion of allocated treatment was substantially less good in the prolonged 42 week multi-drug regime compared to the two drug arm. The third study 80961 investigated interval compression i.e. if the CDDP/DOX when given every 2 weeks with GCSF superior to the same two drugs given every 3 weeks. There was no difference in survival between the arms, although there was a better histologic response rate in the compressed arm. Three randomised controlled trials on this rare disease have taken more than 20 years to accrue a sufficient sample of patients. The overall outcome has changed little in this time. Large multinational studies are needed to be able to answer these important questions in a timely fashion.
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PMID:Osteosarcoma: the European Osteosarcoma Intergroup (EOI) perspective. 2021 95


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