[Progress and stagnation in chemotherapy protocols for primary osteosarcoma]

Thirty years ago, osteosarcoma of a limb meant amputation and death. Two years after diagnosis, 80% of the patients died from pulmonary metastases, despite early amputation. In 2002, more than 70% of these patients can be cured. Successful cure requires adequate and early management centered on en-bloc resection by a specialized surgeon, followed by a long, expensive, and adapted chemotherapy. The cornerstone is high-dose methotrexate. We present data accumulated over the last 30 years on the treatment of osteosarcoma and point out the fundamental steps of this success story.