Journal of Clinical Oncology, Vol 10, 1579-1591, Copyright © 1992 by American Society of Clinical Oncology
A comparison of two short intensive adjuvant chemotherapy regimens in operable osteosarcoma of limbs in children and young adults: the first study of the European Osteosarcoma Intergroup
VH Bramwell, M Burgers, R Sneath, R Souhami, AT van Oosterom, PA Voute, J Rouesse, D Spooner, AW Craft and R Somers
London Regional Cancer Centre, East London, Canada.
PURPOSE: A randomized pilot study was undertaken to assess the acute and
chronic toxicities of two short intensive chemotherapy regimens, and to
evaluate the feasibility of conservative surgery in this setting.
Additional aims were to determine the clinical and radiologic response and
the degree of histologic necrosis after chemotherapy. With extension of the
study, eventual accrual was sufficient to compare disease-free survival
(DFS) and overall survival (OS). PATIENTS AND METHODS: Between July 1983
and December 1986, the European Osteosarcoma Intergroup (EOI) entered 198
eligible patients with classic high-grade extremity osteosarcoma onto a
randomized trial that compared doxorubicin (DOX) 25 mg/m2/d times three,
intravenous (IV) bolus plus cisplatin (CDDP) 100 mg/m2, 24 hour infusion,
every 3 weeks times six; the same combination was preceded 10 days earlier
by high-dose methotrexate (HDMTX) 8 g/m2, 6-hour infusion, every 4.5 weeks
times four. In the majority of patients (179), chemotherapy was commenced
after biopsy; definitive surgery was scheduled at 9 weeks in both groups.
RESULTS: Toxicities for both regimens did not differ substantially from
those that occurred in other trials of adjuvant chemotherapy in
osteosarcoma. Local recurrence (9%) and surgical complications (18%) after
conservative surgery were acceptable. With a median follow-up of 53 months,
DFS at 5 years is superior (P = .02) for DOX/CDDP, 57% versus 41%, although
OS, 64% versus 50%, is not different significantly (P = .10). In a subset
of 66 patients for whom pathologic data on the resected specimen were
available, DFS (P = .003) and OS (P = .008) were better for those who
demonstrated > or = 90% necrosis. CONCLUSION: A brief intensive
chemotherapy regimen of DOX/CDDP has produced excellent long-term results,
which are similar to those that have been achieved in cooperative group
studies of longer, more complex multiagent chemotherapy, and provide the
basis for a direct comparison in the next EOI study.
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