Primary chemotherapy and delayed surgery for malignant fibrous histiocytoma of bone in the extremity

Tumori. 1990 Dec 31;76(6):537-42. doi: 10.1177/030089169007600604.

Abstract

Between March 1983 and September 1988, 22 patients with non-metastatic malignant fibrous histiocytoma MFH of bone of the extremities were treated with two regimens of neo-adjuvant chemotherapy successively activated. Preoperatively, the patients received moderate doses of methotrexate and cisplatinum-Regimen 1- or high dose methotrexate, cisplatinum and adriamycin-Regimen 2. Cisplatinum was delivered intraarteriously, the other drugs intravenously. Limb salvage surgery was performed in 20 patients, and 2 patients were amputated. The surgical margins were adequate (radical or wide) in 18 cases and inadequate (marginal) in 4. The histologic response to chemotherapy was good (90% or more tumor necrosis) in 8 patients. In both regimens postoperative chemotherapy was tailored according to the grade of necrosis determined by preoperative treatment on the primary tumor. At an average follow-up of 40 months (15-70), 15 patients (68%) remained continuously disease-free and 7 relapsed with metastases. No local recurrences were observed. Regimen 2 was slightly more effective than Regimen 1 in terms of good histologic response (5/10 vs 1/12) and continuous disease-free survival (8/10 vs 7/127). The results demonstrate that, as in osteosarcoma, in non-metastatic malignant fibrous histiocytoma of bone in the extremities a high percentage of patients can be cured with neoadjuvant chemotherapy and that in most of them limb sparing surgery is possible and safe.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Amputation, Surgical
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bone Neoplasms / mortality
  • Bone Neoplasms / pathology
  • Bone Neoplasms / therapy*
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Drug Administration Schedule
  • Female
  • Femoral Neoplasms / mortality
  • Femoral Neoplasms / pathology
  • Femoral Neoplasms / therapy*
  • Histiocytoma, Benign Fibrous / mortality
  • Histiocytoma, Benign Fibrous / pathology
  • Histiocytoma, Benign Fibrous / therapy*
  • Humans
  • Humerus*
  • Infant
  • Male
  • Middle Aged
  • Survival Analysis
  • Tibia*