A Retrospective Comparison Of Pirarubicin-based And Doxorubicin-based Combination Chemotherapy For Non-metastatic Osteosarcoma Of The Extremity：a Single Institution Experience

Objective： We retrospectively compared the efficacy and toxicity of high-dosemethotrexate (HDMTX), cisplatin (DDP) and ifosfamide (IFO) in combinationwith doxorubicin (DOX) or pirarubicin (THP) in non-metastatic osteosarcoma toknow whether the THP-based chemotherapy has more benefit comparing toDOX-based chemotherapy.Methods:96patients with high-grade, localized extremity osteosarcoma,treated with HDMTX, DDP and IFO in combination with DOX (DOX-based, n=49) or THP (THP-based, n=47) pre-and post-operatively between December2005and July2008, were reviewed. The regimens were modified from thepreviously published protocol (IOR-OS/N-5: Instituto Ortopedic Rizzoli-Sectionof Osteosacorma/Neoadjuvant chemotherapy-5). Patients received two cycles ofDOX-based or THP-based chemotherapy prior to surgery and three cycles of thesame drugs for good histological responders (tumor necrosis≥90%) or fourcycles for poor histological responders post-operatively. Results: The groups did not differ in the good histologic response rate(THP-based,61.7%vs. DOX-based,59.2%, P=0.801), limb salvage rate(THP-based,74.4%vs. DOX-based,67.3%, P=0.443), or local recurrence rate(THP-based,4.3%vs. DOX-based,6.1%, P=1.000), but a tendency towardincreased5-year survival (event-free survival:70.2%vs.53.1%, P=0.084;overall survival:78.7%vs.61.2%; P=0.062) and decreased5-year lungmetastasis rate (23.4%vs.40.8%; P=0.068) was observed in the THP-basedgroup. In toxicity profiles, THP-based group had a lower incidence of nauseaand vomiting, alopecia, mucositis and arrhythmia.Conclusions： THP-based regimen seems to be an effective and safechemotherapeutic strategy for patients with high grade, non-metastatic extremityosteosarcoma.