[Neoadjuvant treatment in osteosarcomas]

The dismal prognosis of osteosarcoma of the limbs treated by amputation alone can be improved dramatically by including chemotherapy in an interdisciplinary regimen. Neoadjuvant chemotherapy is commonly used in order to eradicate the micrometastases and to prepare for limb-salvage surgery. To-days conservative surgery is possible in the majority of patients, including young children, and relapse-free survival attains 50-80%. High-dose methotrexate, doxorubicine, cis-platin and ifosfamide are considered the most active drugs against osteosarcoma. However, the best combination of drugs remains controversial with pending questions regarding the number of drugs to give for the preoperative phase of treatment and the value of salvage chemotherapy in poor histological responders. Furthermore long term toxicity of the drugs need to be better assessed. In order to answer these questions, treatment should be administered within the scope of prospective multi-centre trials.