The 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.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations
were conducted in conformity with ethical principles of research, and that informed consent for participation in the study
was obtained.