Results of the Scandinavian Sarcoma Group XIV protocol for classical osteosarcoma: 63 patients with a minimum follow-up of 4 years

• Published in: Acta orthopaedica 2011-04, Vol.82 (2), p.211-216
• Main Authors: Smeland, Sigbjørn, Bruland, Øyvind S, Hjorth, Lars, Brosjö, Otte, Bjerkehagen, Bodil, Österlundh, Gustaf, Jakobson, Åke, Hall, Kirsten Sundby, Monge, Odd R, Björk, Olle, Alvegaard, Thor A
• Format: Article
• Language: English
• Subjects: Adjuvant; administration & dosage; Adolescent; Adult; Antibiotics; Antibiotics, Antineoplastic - administration & dosage; Antineoplastic; Antineoplastic Agents; Antineoplastic Agents - administration & dosage; Antineoplastic Combined Chemotherapy Protocols; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Biological and medical sciences; Bone Neoplasms; Bone Neoplasms - drug therapy; Bone Neoplasms - mortality; Bone Neoplasms - surgery; Chemotherapy; Chemotherapy, Adjuvant; Child; Cisplatin; Cisplatin - administration & dosage; Clinical Medicine; Diseases of the osteoarticular system; Doxorubicin; Doxorubicin - administration & dosage; drug therapy; Female; Finland; Follow-Up Studies; Humans; Ifosfamide; Ifosfamide - administration & dosage; Immunologi inom det medicinska området; Immunology in the medical area; Klinisk medicin; Male; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Methotrexate; Methotrexate - administration & dosage; mortality; Norway; Orthopedics; Ortopedi; Osteosarcoma; Osteosarcoma - drug therapy; Osteosarcoma - mortality; Osteosarcoma - surgery; surgery; Sweden; Treatment Outcome; Tumors of striated muscle and skeleton; Young Adult
• ISSN: 1745-3674; 1745-3682; 1745-3682
• DOI: 10.3109/17453674.2011.566141

Background and purpose The Scandinavian Sarcoma Group (SSG) XIV protocol is based on experience from previous SSG trials and other osteosarcoma intergroup trials, and has been considered the best standard of care for patients with extremity localized, non-metastatic osteosarcoma. We analyzed the outcome in 63 consecutive patients. Patients and methods From 2001 through 2005, 63 patients recruited from centers in Sweden, Norway, and Finland were included. They received preoperative chemotherapy consisting of 2 cycles of paired methotrexate (12 g/m 2 ), cisplatin (90 mg/m 2 ), and doxorubicin (75 mg/m 2 ). 3 cycles were administered postoperatively, and poor histological responders were given 3 additional cycles of ifosfamide (10-12 g/m 2 ) as a salvage strategy. Results With a median follow-up of 77 months for survivors, the estimated metastasis-free and sarcoma-related survival at 5 years was 70% and 76%, respectively. 53 patients were treated with limb salvage surgery or rotationplasty and 2 patients experienced a local recurrence. 3 toxic deaths were recorded, all related to acute toxicity from chemotherapy. The 5-year metastasis-free survival of poor histological responders receiving add-on treatment with ifosfamide was 47%, as compared to 89% for good histological responders. Interpretation Outcome from the SSG XIV protocol compares favorably with the results of previous SSG trials and other published osteosarcoma trials. However, salvage therapy given to poor responders did not improve outcome to a similar degree as for good responders. In a multi-institutional setting, more than four-fifths of the patients were operated with limb salvage surgery or rotationplasty, with few local recurrences.