Fig. 21-4. Chemotherapy regimen. The timing of surgery was determined by randomization to be performed at either week 0 or week 10; administration of high-dose methotrexate and leucovorin rescue; AP, doxorubicin and cisplatin administration; BCD, cyclophosphamide, bleomycin, and dactinomycin; and III, doxorubicin administration. (From Goorin AM, Schwartzentruber DJ, Devidas M, Gebhardt MC, Ayala AG, Harris MB, Helman LJ, Grier HE, Link MP. Presurgical chemotherapy compared with immediate surgery and adjuvant chemotherapy for non-metastatic osteosarcoma: Pediatric Oncology Group Study POG-8651. J Clin Oncol 2003;21:1574-80, with permission.) An alternative regimen is outlined in Fig. 21-5.
MTX CDP MTX IFO IFO Surgery
ADM CDP ADM
MTX: Methotrexate (MTX) 12 g/m2 as 6 h intravenous (i.v.) infusion. The dose of MTX are escalated by 2 g/m2 if after 6 h the serum measurement of the drug in the previous course was <1.000 ^mol/l (top dose 24 g).
CDP/ADM: 120 mg/m2 cisplatin (CDP) intraarterially (i.a.) or i.v. as a 72 h continuous infusion and 60 mg/m2 doxorubicin (ADM) as an 8 h infusion starting 48 h after the beginning of the CDP infusion.
IFO/CDP: 3 g/m2/day ifosfamide (IFO) as a 1 h infusion for 2 consecutive days followed by 120 mg/m2 CDP i.a. or i.v. as a 72 h continuous infusion.
IFO/ADM: 3 g/m2/day IFO as a 1 h infusion for 2 days followed by 30 mg/m2/day ADM in a 4 h infusion for 2 days.
Was this article helpful?