Current management, local management, and survival statistics of high-grade osteosarcoma. Experience in Japan

To report the current management of high-grade osteosarcoma in Japan, the authors studied the results of 55 cases treated in the authors' institutions and data provided by Osaka University (59 cases), Chiba Oncology Group (97), and Sapporo National Hospital (70). Twenty-five of the 55 cases in the authors' series were treated by limb-salvage surgery, 27 by amputation, and the remainder by chemotherapy. In all 226 cases from the three institutes, 106 were treated by amputation and 120 by limb-salvage surgery. Two local recurrences (4%) were found in the authors' series, three in the Osaka series, and eight in the Chiba series. Five-year accumulative survival rates in this study showed some differences, depending upon the institution or upon the protocol employed: in the authors' series it was 60% overall and 68% for a stronger chemotherapy group; in the Osaka series, it was 50% in a mild chemotherapy group and 72% in an intensive chemotherapy group; and in the Sapporo series, it was 36% and 73%, respectively. This study showed that local control of IIB osteosarcoma was successfully achieved by preoperative adjuvant chemotherapy and wide resection, and that an intensive chemotherapeutic combination of high-dose methotrexate, cisplatinum, and doxorubicin is promising.