According to a recent article published in the journal
Cancer, surgery appears to be an integral treatment component for achieving a cure in localized osteosarcoma.
Osteosarcoma is a cancer that starts in the bone. It is a disease that mainly affects young adults or adolescents. The most common site of cancer origin is in the bones around the knee. At present, patients are grouped according to whether the cancer is localized (has not spread from its site of origin) or metastatic (spread to distant sites in the body). Osteosarcoma of the extremity refers to cancer that is limited to one limb and has not spread to the rest of the body. The current therapy for osteosarcoma employs different treatment modalities. Generally, patients are treated with pre-operative chemotherapy, surgery which often includes amputation and post-operative chemotherapy. This treatment strategy has reported cure rates of 50-60%. However, with the advent of new chemotherapy agents and/or combinations, researchers have been investigating the use of chemotherapy alone as a means to cure patients in order to avoid debilitating surgery.
Researchers from the M.D. Anderson Cancer Center in Houston, Texas recently reported long-term results from a clinical trial conducted to determine if chemotherapy alone could be effective treatment for patients with localized osteosarcoma. This trial involved 31 pediatric patients who initially received either high-dose methotrexate and leucovorin (3 patients) or Platinol® (cisplatin) (28 patients). All patients demonstrated a complete disappearance of cancer (complete remission) following initial therapy and went on to receive maintenance chemotherapy for 18-21 months consisting of methotrexate/leucovorin, Platinol® and doxorubicin (Adriamycin®). Four patients requested the surgical removal of their cancer while in complete remission.
Overall, only 3 patients (10% of patients in the trial) who received chemotherapy only remained free of cancer at over 200 months following therapy. The 4 patients who underwent surgery while in complete remission had no detectable cancer cells in the surgical specimens and therefore may have been cured with chemotherapy alone. Regardless, the cure rate achieved in this trial utilizing chemotherapy only as treatment, compared to the cure rates achieved with conventional therapy in most institutions involving surgery is suboptimal.
The researchers concluded that treatment exclusively utilizing chemotherapy for the treatment of localized osteosarcoma in pediatric patients does not appear to be justified as standard treatment due to the low cure rates achieved in this study. However, this study involved a small number of patients and different chemotherapy regimens may provide different overall results. Parents of children with osteosarcoma may wish to speak with their physician about the risks and benefits of differing therapeutic regimens or the participation in a clinical trial evaluating other novel treatment approaches.
Reference: Jaffe N, Carrasco H, Raymond K, et al. Can cure in patients with osteosarcoma be achieved exclusively with chemotherapy and abrogation of surgery?