Atlas of Musculoskeletal Tumors and Tumorlike Lesions by Piero Picci Marco Manfrini Nicola Fabbri Marco Gambarotti & Daniel Vanel

Author:Piero Picci, Marco Manfrini, Nicola Fabbri, Marco Gambarotti & Daniel Vanel
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

44.2 Salvage Chemotherapy

While no doubt can be raised on the importance of chemotherapy in the first-line treatment of osteosarcoma, the use of chemotherapy after relapse is still under discussion. Complete surgical remission of all sites of recurrence is pivotal for survival after relapse, but the role of chemotherapy has been recently emphasized in patients with a relapse-free interval shorter than 24 months (Chou et al. 2005). In particular, the use of high-dose ifosfamide was recommended to prevent or delay a second recurrence (Chou et al. 2005). In a paper on the same topic, reporting a monoinstitutional experience, only complete surgical removal of metastatic disease was reported as important for long-term survival (Crompton et al. 2006; Ferrari et al. 2003).

The results obtained in patients with synchronous metastases, in spite of an aggressive surgical and chemotherapeutical approach, are worse than those obtained in patients without evident metastases at diagnosis (Daw et al. 2006; Bacci et al. 2003).

A recent paper reported improved results in patients metastatic at presentation who received MTP-PE added to the classical chemotherapy (Chou et al. 2009).

A possible different strategy is suggested in a recent article (Grignani et al. 2012) describing the use of multikinase inhibitor sorafenib. These data make it worthwhile to test the use of sorafenib in a larger population of patients with osteosarcoma and possibly in combination with classic antineoplastic agents.

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