Experience with multiagent chemotherapy for osteosarcoma. Improved outcome

Clinical researches at the authors' institution have been treating patients with osteosarcoma with effective adjuvant chemotherapy for 18 years, including 14-years experience with limb-salvage surgery. The outlook for patients with nonmetastatic high-grade osteosarcoma has improved dramatically since 1972. Updated results of the single-agent adjuvant (postoperative) chemotherapy trial project a five-year disease-free survival (DFS) of 42% (95% confidence interval [CI], 14% to 70%) with follow-up periods of 5.7 to 13.8 years compared to a two-year DFS of 78% (60% to 95%) and follow-up periods of 0.6 to 6.8 years with six-agent, alternating, adjuvant postoperative chemotherapy. Additionally, since limb-salvage surgery began to be offered in 1976 to selected patients, 36 of 74 patients (49%) have had limb-salvage operations performed. The two-year DFS is 69% (52% to 85%) for patients having limb-salvage operations with follow-up periods of 0.6 to 10.3 years compared to 72% (57% to 87%) for amputees with follow-up periods of 0.3 to 10.3 years. It is concluded that patients receiving limb-salvage operations appear to be at no greater risk for relapse than patients receiving cross-bone amputation and that the administration of alternating, multiagent, adjuvant chemotherapy has significantly improved the DFS for patients who present with nonmetastatic high-grade osteosarcoma.