Objective:

To report event-free overall survival rates and histological response results for neoadjuvant chemotherapy and limb-salvage surgery in conventional osteosarcoma patients treated without high methotrexate doses in the National Cancer Institute of Colombia.

Patients and Methods:

A cohort of under 21-year old patients diagnosed with conventional osteosarcoma, with or without metastasis, underwent preoperative chemotherapy for twelve weeks, followed by local control surgery in week 15, and three postoperative chemotherapy cycles. Treatment did not include methotrexate. Four drugs were administered: ifosfamide, doxorubicin, cisplatin, and etoposide. The Kaplan-Meier method was used to calculate overall survival and event-free rates. A multivariate analysis of survival predictors was carried out with the Cox proportional hazards method. Statistical analysis was based on an α of 0.05.

Results:

From January 1997 to December 2007, a total of l22 conventional osteosarcoma patients received treatment, with a median follow-up of 24.4 months (range 1.13 to 169). The mean patient age was 13.7 years (SD ±2.9 yrs). Limb-salvage surgery was performed in 52% and ablative surgery in 38%. Overall survival and event-free rates were higher in the good responders to chemotherapy than in the poor responders: (HR = 4.33; 95% CI; 1.77-10.58) and (HR = 2.90; 95% CI; 1.60-5.27. The overall survival and event-free rates were different between patients with and without metastasis at diagnosis: (HR = 2.13; 95% CI; 0.97-4.72) and (HR = 2.07; (95% CI; 1.10-3.90.

Conclusion:

Osteosarcoma can be treated with chemotherapy without high methotrexate doses to achieve moderately effective survival rates comparable with those in developed countries.

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