12/28/99
Page 1/2
OSTEOSARCOMA OUTCOME OF THERAPY BASED ON HISTOLOGIC RESPONSE
ROADMAP – All Patients
NAME: ___________________________________ MR#:
______________________
Ht:
____________(cm) Wt:
____________(kg) BSA:____________
PRE STUDY:
History/Physical;
CBC/diff/plts: Lytes, BUN, Cr, Ca, Mg, PO4, ALT/AST, Bili, Alk phos LDH; UA;
Echo/Muga Audiogram;
X-Rays of primary site + chest; CT chest; Bone Scan; MRI primary incl. Joints
proximal & distal;
GFR scan; Biopsy + tissue for biologic studies; Central line placement;
WEEK DAY DATE DATE AGENT/DOSE STUDIES/ACTION
DUE DONE
Requirements prior to
starting Cisplat & Dox cycles: ANC ³
750/ml; creatinine
<1.5 x baseline or creatinine clearance >60ml/min/1.73 m2 and
bili <3.0mg/dl
Requirements prior to
starting Methotrexate cycles:
ANC>200/ml
platelets> 50,000/ml;
creatinine<1.5 x baseline or creatinine clearance >60ml/min/1.73 m2 &
mucositis resolving. Total bili, 1.2
mg/dl; ALT(SGPT) <10.0 x normal.
0 1 _____ _____ Cisplatin _________mg pre-study labs as above
Doxorubicin ______mg
Dexrazoxane
______mg
2 _____ _____ Cisplatin _________mg
Doxorubicin ______mg
Dexrazoxane
______mg
3 G-CSF __________mg
1 _____
2 _____
3 1 _____ _____ Methotrexate ______mg H&P; CBCD/p, Lytes, Cr, Ca.
Mg,
PO4, ALT/AST, Bili, Alk
phos,
LDH
4 1 _____ _____ Methotrexate ______mg H&P; CBCD/p, Lytes, Cr, Ca.
Mg,
PO4, ALT/AST, Bili, Alk
phos,
LDH
5 1 _____ _____ Cisplatin _________mg H&P; CBCD/p, Lytes, Cr, Ca.
Doxorubicin ______mg Mg,
PO4, ALT/AST, Bili, Alk
Dexrazoxane
______mg phos, LDH
2 _____ _____ Cisplatin _________mg
Doxorubicin ______mg
Dexrazoxane
______mg
3 G-CSF __________mg
12/28/99
Page 2/2
OSTEOSARCOMA OUTCOME OF THERAPY BASED ON HISTOLOGIC RESPONSE
ROADMAP – All Patients
NAME:
______________________________ MR#:
______________________
WEEK DAY DATE DATE AGENT/DOSE STUDIES/ACTION
DUE DONE
6 1 _____ _____
7 _____
8 1 _____ _____ Methotrexate ______mg H&P; CBCD/p, Lytes, Cr, Ca.
Mg,
PO4, ALT/AST, Bili, Alk
phos,
LDH
9 1 _____ _____ Methotrexate ______mg H&P; CBCD/p, Lytes, Cr, Ca.
Mg,
PO4, ALT/AST, Bili, Alk
phos,
LDH
10 1 _____ H&P;
CBCD/p,; ALT/AST; Bili,
Alk
phos, LDH; X-ray of 10 site
and
chest, Bone Scan, CT chest,
MRI
of primary incl. Joints
proximal
& distal; GFR,
Audiogram
11 1 _____ Surgery
of 10 site. Surgery for
mets
when feasible. Send tissue
for
CGAP studies.
12 _____
13 _____
Obtain other studies as required for good patient care
Patients
with histologic response of ³98%
necrosis will continue therapy with cisplatin (2 courses), Doxorubicin (4 courses)
and Methotrexate (8 courses).
Patients
with histologic response of <98% necrosis will undergo peripheral stem cell
harvest and be treated with 3 courses cyclophosphamide and melphalan with
peripheral stem cell support.
Patients with
unresectable primary or those with metastases at diagnosis will undergo
peripheral stem cell harvest during the recovery phase following the first or
second course of cisplatin and doxorubicin chemotherapy of the neoadjuvant
phase prior to definitive surgery.