{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T16:51:51Z","timestamp":1791046311546,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2002,10,31]],"date-time":"2002-10-31T00:00:00Z","timestamp":1036022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2002,11,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Contemporary therapy for osteosarcoma is comprised of initial treatment with chemotherapy and surgical extirpation of the primary tumor in the affected bone. In view of the major advances forged by chemotherapy in the treatment of the primary tumor, an attempt was made to destroy the tumor exclusively with this therapeutic modality and abrogate surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Thirty\u2010one consecutive patients were treated. All had localized disease (absence of metastases) at the time of diagnosis. Initial treatment with chemotherapy was comprised of high\u2010dose methotrexate and leucovorin rescue (MTX\u2010LF) in 3 patients and intraarterial cisplatin in 28 patients. Clinical, radiologic, angiographic, radionuclide, and histologic investigations were utilized to assess the efficacy of treatment. After a response at 3 months, entry into the study was permitted and treatment was maintained for a total of 18\u201321 months with a combination of agents comprised of MTX\u2010LF, intraarterial cisplatin, and doxorubicin. Patients were monitored closely for disease recurrence with the investigations outlined earlier. Two informed consents were required: one at the time of diagnosis and another at 3 months after the initial response had been attained.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Only 3 of 31 patients were cured with the administration of chemotherapy alone. Local recurrence and pulmonary metastases were not reported to develop in these 3 patients during a follow\u2010up period of 204+ to 225+ months. Four other patients also possibly were cured with chemotherapy alone. At their request, several months after the cessation of chemotherapy, they underwent surgical extirpation of the tumor. No evidence of viable tumor was found. These patients remained free of disease for 192+ to 216+ months. Thus, only seven patients did not develop local recurrence and\/or pulmonary metastases. Among the remaining 24 patients, 9 developed local recurrences without pulmonary metastases 14\u201374 months (median, 30 months) after the initial response. Eight of the nine patients were rendered tumor free by extirpation of the local recurrence. Two of these eight patients subsequently died, one of the acquired immunodeficiency syndrome (AIDS) and the other of varicella septicemia. The ninth patient refused amputation and died of metabolic complications. Three other patients developed local recurrences 20\u201369 months and pulmonary metastases 10\u201398 months after achievement of the initial response. These patients were rendered tumor free by extirpation of the local recurrence and metastasectomy. One of these patients also later died of AIDS. In the remaining 12 patients, local recurrences developed 5\u201329 months (median, 14 months) after the initial response was achieved. The patients also developed pulmonary metastases 11\u201360 months after the initial response. In eight patients the local recurrences were extirpated and metastasectomy was performed; however, these patients later died of recurrent pulmonary metastases. The remaining four patients refused to undergo extirpation of the local recurrence. The pulmonary metastases were not resected. They failed to respond to alternate therapy. Thus, the tumor\u2010free survival rate was 23% (7 of 31 patients): 3 patients who were treated with chemotherapy only and 4 patients who were treated with chemotherapy plus surgery. The overall survival rate (patients who remained free of disease and those who underwent resection for local recurrence and metastasectomy) was 48% (15 of 31 patients). Prior to the deaths from AIDS and varicella septicemia, the overall survival was 58% (18 of 31 patients).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Utilizing the regimen employed in the current study, only 3 of 31 patients with osteosarcoma (10%) were cured exclusively with chemotherapy. Four additional patients who underwent extirpation of the primary tumor without disease recurrence and in whom no viable tumor was found in the resected specimens possibly could increase the number of patients who potentially were cured with chemotherapy to 7 (23%). With an overall expected cure rate of 50\u201365% with \u201cconventional\u201d strategies, the results of the current study do not justify the adoption of current forms of chemotherapy as exclusive treatments for osteosarcoma. Cancer 2002;95:2202\u201310. \u00a9 2002 American Cancer Society.<\/jats:p>\n                    <jats:p>DOI 10.1002\/cncr.10944<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncr.10944","type":"journal-article","created":{"date-parts":[[2002,11,1]],"date-time":"2002-11-01T09:14:49Z","timestamp":1036142089000},"page":"2202-2210","source":"Crossref","is-referenced-by-count":96,"title":["Can cure in patients with osteosarcoma be achieved exclusively with chemotherapy and abrogation of surgery?"],"prefix":"10.1002","volume":"95","author":[{"given":"Norman","family":"Jaffe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Humberto","family":"Carrasco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Raymond","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Ayala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farzin","family":"Eftekhari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2002,10,31]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19820315)49:6<1221::AID-CNCR2820490625>3.0.CO;2-E"},{"key":"e_1_2_5_3_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1990.8.12.1988"},{"key":"e_1_2_5_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1988.6.2.329"},{"key":"e_1_2_5_5_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1992.10.1.5"},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198606193142502"},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4613-2563-5_9"},{"key":"e_1_2_5_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.1975.136"},{"key":"e_1_2_5_9_2","series-title":"Adjuvant therapy of cancer","first-page":"601","author":"Benjamin RS","year":"1984"},{"key":"e_1_2_5_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-94-009-2691-2_45"},{"key":"e_1_2_5_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19850801)56:3<461::AID-CNCR2820560308>3.0.CO;2-L"},{"issue":"7","key":"e_1_2_5_12_2","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1200\/JCO.1983.1.7.428","article-title":"Treatment of primary osteosarcoma with intra\u2010arterial and intravenous high\u2010dose methotrexate","volume":"1","author":"Jaffe N","year":"1983","journal-title":"J Clin Oncol."},{"key":"e_1_2_5_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19830201)51:3<402::AID-CNCR2820510308>3.0.CO;2-P"},{"key":"e_1_2_5_14_2","first-page":"212","article-title":"Osteosarcoma chemotherapy effect: a prognostic factor","volume":"4","author":"Raymond AK","year":"1987","journal-title":"Semin Diagn Pathol."},{"key":"e_1_2_5_15_2","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1958.10501452"},{"key":"e_1_2_5_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19870501)59:9<1577::AID-CNCR2820590908>3.0.CO;2-P"},{"key":"e_1_2_5_17_2","first-page":"742","article-title":"Auditory function in pediatric patients treated with multiple doses of cis\u2010Diamminedichloroplatinum II (CDP)","volume":"49","author":"Ruiz L","year":"1989","journal-title":"Cancer Res."},{"key":"e_1_2_5_18_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1983.1.4.251"},{"key":"e_1_2_5_19_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1985.3.8.1101"},{"key":"e_1_2_5_20_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1997.15.6.2378"},{"key":"e_1_2_5_21_2","first-page":"1699","article-title":"Is it ethical not to conduct a prospectively controlled trial of adjuvant chemotherapy in osteosarcoma?","volume":"66","author":"Lange B","year":"1982","journal-title":"Cancer Treat Rep."},{"key":"e_1_2_5_22_2","first-page":"743","article-title":"Response to \u201cIs it ethical not to conduct a prospectively controlled trial of adjuvant chemotherapy in osteosarcoma?\u201d","volume":"67","author":"Jaffe N","year":"1982","journal-title":"Cancer Treat Rep."},{"key":"e_1_2_5_23_2","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1200\/JCO.1984.2.10.1179","article-title":"Adjuvant chemotherapy in osteogenic sarcoma","volume":"2","author":"Jaffe N","year":"1984","journal-title":"J Clin Oncol."},{"key":"e_1_2_5_24_2","first-page":"744","article-title":"Reply: role of adjuvant therapy in osteosarcoma","volume":"67","author":"Link MP","year":"1983","journal-title":"Cancer Treat Rep."},{"key":"e_1_2_5_25_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1984.2.3.147"},{"key":"e_1_2_5_26_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19840615)53:12<2615::AID-CNCR2820531208>3.0.CO;2-S"},{"key":"e_1_2_5_27_2","first-page":"265","article-title":"Multidrug adjuvant chemotherapy for osteosarcoma: interim report of the Southwest Oncology Group Studies","volume":"62","author":"Sutow WW","year":"1977","journal-title":"Cancer Treat Rep."}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fcncr.10944","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.10944","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T16:42:53Z","timestamp":1760287373000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.10944"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2002,10,31]]},"references-count":26,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2002,11,15]]}},"alternative-id":["10.1002\/cncr.10944"],"URL":"https:\/\/doi.org\/10.1002\/cncr.10944","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2002,10,31]]}}}