Controversies in the treatment of osteosarcoma

In my opinion, it is clear that improving the initial disease-free survival is the key to improving the cure rates for patients with osteosarcoma. However, until new drugs with marked activity against osteosarcoma are developed, significant improvements in disease-free survival are unlikely. Almost all patients with newly-diagnosed osteosarcoma will receive preoperative chemotherapy which is followed by a definitive surgical (limb-sparing or amputation) procedure and additional postoperative chemotherapy. The impact of limb-sparing surgery on the incidence of pulmonary metastases and long-term disease-free survival must be assessed carefully in continuing and future trials. It is conceivable that limb-sparing surgery may be contraindicated in certain situations. The cure rate after the development of metastatic disease must be assessed, although I fear that it will be quite low. Lastly, and possibly most importantly, the assessment of biological variables such as tumour ploidy, enzyme content, and so on, should be undertaken in an effort to promote a better understanding of osteosarcoma.