The value of serial arteriography in osteosarcoma: delivery of chemotherapy, determination of therapy duration, and prediction of necrosis
| Autor: | Ioana Hinshaw, John W. Cullen, Walt Madsen, Brandt A. Jamroz, Sidney L. Stevens, Ross M Wilkins, Patsy McGuire Cullen, Anne B. Camozzi, Cynthia M. Kelly, Kyle Fink, Sandford D. Peck |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Necrosis Adolescent medicine.medical_treatment Bone Neoplasms Histiocytoma Malignant Fibrous Antineoplastic Combined Chemotherapy Protocols medicine Humans Infusions Intra-Arterial Radiology Nuclear Medicine and imaging Doxorubicin Stage (cooking) Child Infusions Intravenous Neoadjuvant therapy Aged Cisplatin Chemotherapy Osteosarcoma medicine.diagnostic_test Neovascularization Pathologic business.industry Angiography Middle Aged medicine.disease Neoadjuvant Therapy Chemotherapy Adjuvant Child Preschool Female medicine.symptom Cardiology and Cardiovascular Medicine Nuclear medicine business medicine.drug |
| Zdroj: | Journal of vascular and interventional radiology : JVIR. 16(8) |
| ISSN: | 1051-0443 |
| Popis: | PURPOSE To investigate the value of serial arteriography to assess tumor response, predict necrosis, and individualize the duration of a combined intravenous (IV) and intraarterial (IA) neoadjuvant chemotherapy protocol in patients with biopsy-proven high-grade osteosarcoma or malignant fibrohistiocytoma of bone. MATERIALS AND METHODS Between July 1987 and March 2003, 109 patients completed a chemotherapy protocol of neoadjuvant IV doxorubicin and IA cisplatin. Patients were eligible regardless of age, disease stage, or disease site. A minimum of three IA cycles followed by definitive surgery was required for inclusion in the final analysis. IA dose and duration were increased for tumors larger than 10 cm. Initial arteriograms were scored as indicating mild, moderate, or marked tumor neovascularity (TNV). Subsequent arteriograms were prospectively compared with the baseline image for percent change in TNV. Treatment continued until a maximum of five cycles were administered or one of three criteria were met: (i) at least 90% decrease in TNV, (ii) plateau of effect, or (iii) no response. RESULTS Of 408 IA procedures, 42 patients underwent three cycles, 53 underwent four, and 14 required five cycles of neoadjuvant therapy. There was a 2.5% minor complication rate. Eighty-six percent of patients exhibited at least 90% decrease in TNV and 82% exhibited good histologic response (≥90% tumor necrosis). Serial arteriography predicted a good histologic response with an accuracy of 90% and a sensitivity of 97%. CONCLUSIONS Serial arteriography was highly sensitive and accurately predicted good responses. This individually modified, dose-intensified neoadjuvant protocol yielded an excellent histologic response rate with minimal complications. Future endeavors should involve a multiinstitutional study of this unique approach. |
| Databáze: | OpenAIRE |
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