Reactions Weekly | 2021
Ifosfamide/methotrexate
Abstract
Lack of efficacy: case report An approximately 25-year-old man exhibited lack of efficacy during chemotherapy with ifosfamide and methotrexate for osteosarcoma with a rhabdomyosarcoma component. The man was admitted with generalized seizures at the age of 18-years (in December 1995). MRI scan showed a neoplastic lesion in the dura mater. A subtotal tumor resection was performed, and the histopathological diagnosis of anaplastic astrocytoma was made. He was treated with local radiation therapy. In July 2000 (after 5 years), another tumor resection was performed, and histopathological examination revealed an osteosarcoma with a rhabdomyosarcoma component. It was considered that radiationinduced genetic alterations contributed to the rhabdomyosarcoma component. In March 2001, a cranial bone exclusion was performed due to an epidural abscess. The tumor recurred despite eight tumorectomies. The tumor infiltrated the brain and the bone. Following the tumorectomy, between 2002–2004, he received chemotherapy with IV injection of methotrexate 300 mg/kg twice daily for 1 day along with IV injection of ifosfamide 50 mg/kg six times per day for five consecutive days [not all routes stated]. In December 2004, he received conventional radiotherapy. However, both radiotherapy and the chemotherapy were ineffective. He died on 30 July 2005 because of tumor expansion that extended above the skull and forced the skin to separate and extended down into his oral cavity via the sinus frontalis and nasal cavity. An autopsy finding confirmed the diagnosis of an osteosarcoma with a rhabdomyosarcoma component.