Subject(s)
Spinal Neoplasms/secondary , Adult , Aged , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Prognosis , Radiotherapy Dosage , Spinal Neoplasms/radiotherapy , Spinal Neoplasms/surgeryABSTRACT
Preoperative radiotherapy and systemic chemotherapy are effective for reducing the size of a tumor and rendering it resectable. The results achieved with systemic chemotherapy are ultimately reflected in improved survival. Moreover, limb-saving procedure in the treatment of osteosarcoma has become possible with rationality in carefully selected patients. Since 1975, 38 patients with osteosarcoma within an age range of 5 to 56 years, (average 17.9 years) have been treated by fast neutron radiotherapy, systemic chemotherapy and limb-salvage surgery. Twenty-two of these 38 patients underwent en bloc resection of the femur, eight resection of the proximal tibia and five resection of the proximal humerus. Only one of the 38 patients had evidence of local tumor recurrence and overall, 31 patients are currently alive without distant metastasis after 9 to 120 months follow-up. Preoperative fast neutron radiotherapy was employed and it was suggested that fast neutrons had a higher relative biological effectiveness and a greater therapeutic gain factor in comparison with X-rays. Fast neutron radiotherapy thus seems capable of playing a significant role in the treatment of osteosarcoma and is specifically useful for preservation of the affected limb.
Subject(s)
Bone Neoplasms/radiotherapy , Osteosarcoma/radiotherapy , Adolescent , Adult , Bone Neoplasms/mortality , Bone Neoplasms/surgery , Child , Child, Preschool , Combined Modality Therapy , Fast Neutrons/therapeutic use , Female , Humans , Male , Osteosarcoma/mortality , Osteosarcoma/surgery , Preoperative Care , Radiotherapy DosageABSTRACT
A total of 31 patients with malignant bone and soft tissue tumors were evaluated for toxic effects after receiving cisplatin (104 courses) at doses of 2.0-3.0 mg/kg with aggressive hydration. Nausea was common and in 86% of cisplatin courses severe vomiting was observed. Nephrotoxicity was observed in less than 10% of all courses but ototoxicity, especially tinnitis, developed in 5 of 6 patients whose total doses of cisplatin were over 500mg, and one of them showed hearing disorder in the upper frequency above 5,000 Hz. There were no other toxic effects such as severe myelosuppression, allergic reaction or peripheral neuropathy.
Subject(s)
Bone Neoplasms/drug therapy , Cisplatin/adverse effects , Soft Tissue Neoplasms/drug therapy , Adolescent , Adult , Cisplatin/metabolism , Female , Hearing Disorders/chemically induced , Humans , Kidney/drug effects , Male , Middle Aged , Nausea/chemically induced , Tinnitus/chemically induced , Vomiting/chemically inducedABSTRACT
Severe toxicity associated with high-dose methotrexate (HD-MTX) combined with citrovorum factor rescue (CR-Rescue) was evaluated in the 365 courses in 54 patients with osteosarcoma. Anaphylactoid reaction developed in 8 patients (14.8%), 8 courses (2.2%). The mean age was 14 years old. The total dose given was 85770mg in mean and 1840 mg per body weight (kg). The occurrence was proportional to the dose and the number of the course. Plasma MTX concentration remained under 10(-7) mol/l during the episode. Delayed clearance of MTX from plasma was treated with massive CF-Rescue in 10 patients (19%) (the mean age of 13.6), in 12 courses (3.3%), which was observed on an average at the 7th course when the total dose reached to 59530 mg, or 1390 mg per body weight (kg). Neurotoxicity was observed in only one patient (1.9%), one course (0.3%). Severe toxicity associated with HD-MTX therapy tended to occur according to dose escalation and the number of administration. To overcome severe toxicity careful observation of clinical symptoms and signs as well as adequate treatment of side effects without delay are of importance.
Subject(s)
Anaphylaxis/chemically induced , Bone Neoplasms/drug therapy , Methotrexate/adverse effects , Osteosarcoma/drug therapy , Adolescent , Adult , Bone Neoplasms/metabolism , Child , Drug Administration Schedule , Female , Humans , Male , Methotrexate/administration & dosage , Methotrexate/metabolism , Nervous System Diseases/chemically induced , Osteosarcoma/metabolism , Sensation/drug effects , Vomiting/chemically inducedABSTRACT
The pre-operative radiotherapy and systemic chemotherapy is effective in reducing the size of tumor and making the tumor resectable. The results achieved with systemic chemotherapy are ultimately reflected in improved survival. Moreover, limb-saving procedure in the treatment of osteosarcoma has become possible with rationality in carefully selected patients. Sixty-seven patients with osteosarcoma within a range of 5 to 27 years of age were treated at Chiba Cancer Center Hospital in the recent 12 year-duration. Seventeen of 67 patients underwent en bloc resection for osteosarcoma of the femur, (12 patients) and the tibia (5 patients). No patients had evidence of local recurrence of the tumor and overall 15 patients are alive without distant metastasis after 9 to 120 months follow-up. Based on the effective chemotherapy schedule, the limb salvation in the treatment of osteosarcoma is most desirable if it is indicated without risk of decreased radicality of the treatment.
