Neoadjuvant Chemotherapy With Doxorubicin and Cisplatin in Malignant Fibrous Histiocytoma of Bone: A European Osteosarcoma Intergroup Study

• Published in: Journal of clinical oncology Vol. 17; no. 10; pp. 3260 - 3269
• Main Authors: BRAMWELL, V. H. C, STEWARD, W. P, USCINSKA, B, KIRKPATRICK, A. L, MACHIN, D, VAN GLABBEKE, M. M, NOOIJ, M, WHELAN, J, CRAFT, A. W, GRIMER, R. J, TAMINAU, A. H. M, CANNON, S. R, MALCOLM, A. J, HOGENDOORN, P. C. W
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 01-10-1999; Lippincott Williams & Wilkins
• Subjects: Adolescent; Adult; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Bone Neoplasms - drug therapy; Bone Neoplasms - pathology; Chemotherapy; Cisplatin - administration & dosage; Disease Progression; Doxorubicin - administration & dosage; Female; Histiocytoma, Benign Fibrous - drug therapy; Histiocytoma, Benign Fibrous - pathology; Humans; Infusions, Intravenous; Male; Medical sciences; Middle Aged; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Pharmacology. Drug treatments; Survival Analysis; Treatment Outcome; Antineoplastic agent; Human; Drug combination; Prognosis; Sarcoma; Diseases of the osteoarticular system; Malignant tumor; Doxorubicin; Cisplatin; Neoadjuvant treatment; Antibiotic; Chemotherapy; Limb; Malignant histiocytoma; Anthracyclins; Bone; Platinum II Complexes
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.1999.17.10.3260

Studies involving small case series have suggested that malignant fibrous histiocytoma of bone (MFH-B) is a chemosensitive tumor and that chemotherapy may improve survival. In this study, we evaluated clinical and pathologic response rates and survival in a series of patients treated with a consistent chemotherapy regimen of doxorubicin and cisplatin (DOX/DDP).
Study patients were required to have biopsy-proven MFH-B, no previous chemotherapy, and primary or metastatic measurable disease and to be </= 65 years of age. Treatment consisted of doxorubicin 25 mg/m(2)/d days 1 through 3 and cisplatin 100 mg/m(2) by 4-hour intravenous infusion every 3 weeks for six cycles. In patients with operable primary tumors, chemotherapy was planned to start within 42 days of biopsy, with definitive surgery performed after three cycles.
Forty-one patients had operable nonmetastatic limb sarcomas, and 23 (56%) completed six chemotherapy cycles. Limb salvage was possible in 33 patients (80%), and 16 (42%) of 38 assessable specimens showed a good pathologic response (>/= 90% necrosis). Median time to progression was 56 months, and the 5-year progression-free survival rate was 56% (95% confidence interval [CI], 40% to 72%). Median survival time was 63 months, and the 5-year survival rate was 59% (95% CI, 41% to 77%). Patients with a good pathologic response had longer survival times and times to progression than did those with a poor response. Also treated were two patients with locally recurrent and nine with metastatic disease, and these patients had a median survival time of 17.5 months.
Our study suggests that adjuvant or neoadjuvant chemotherapy with DOX/DDP is beneficial in MFH-B. Good pathologic response rates and survivals are quite comparable with those for osteosarcoma, a related bone tumor for which adjuvant or neoadjuvant chemotherapy is an accepted practice.