Prolonged disease-free survival following surgical debulking and high-dose cisplatin/doxorubicin in a patient with bulky metastases from giant cell tumor of bone refractory to "standard" chemotherapy.

A 32-year-old man developed multiple pulmonary metastases from a giant cell tumor of bone. His metastases failed to respond to several chemotherapy regimens (high-dose methotrexate with folinic acid plus doxorubicin 90 mg/m2; cyclophosphamide + bleomycin + actinomycin D; mitoxantrone + dacarbazine; and cisplatin 110 mg/m2). He underwent surgical resection (incomplete) of > 1 kg of tumor from his right lung in March 1985, followed by chemotherapy with menogaril (to which he did not respond). In August 1985, he underwent surgical resection (again, incomplete) of > 1 kg of tumor from his left lung. At the time of surgery, the left and right lung tumors differed histopathologically, with giant cell tumor present in the right lung and sarcoma in his left lung. He received carmustine in October 1985 and mitomycin C in December 1985 without response. His multiple bilateral lung metastases had again become quite large by September 1986. At that time, he received doxorubicin 90 mg/m2 plus cisplatin 120 mg/m2, and for the first time experienced tumor reduction (minor response). He underwent a subtotal resection of right lung and chest wall metastases in December 1986, and underwent subtotal resection of left lung metastases in January 1987. Grossly visible residual tumor was left behind on both sides at the time of surgery, although none was apparent on chest radiograph. He received a final chemotherapy treatment with doxorubicin 90 mg/m2 plus cisplatin 120 mg/m2 on February 2, 1987. He remained free of evidence of residual or recurrent tumor at the time of last followup in February, 1994.