Osteogenic sarcoma: the past, present, and future

The term osteogenic sarcoma (osteosarcoma) is applied to malignant bone-forming tumors, identifiable by the matrix produced, though the histologic pattern may differ greatly. Ths more cellular (osteolytic) forms of the tumor have the poorer prognosis. Other prognostic factors are 1) site of the primary tumor; 2) duration of symptoms; and 3) extent of disease and tumor size. The site of tumor origin is the metaphyseal side of the epiphyseal line. The histogenesis of the tumors accounts for this distribution. Following a diagnostic biopsy, amputation of the extremities remains the treatment of choice. In selected cases, a limb-saving radical en bloc resection may surface. Radiotherapy plays a lesser but important role as adjunctive treatment, and as primary definitive treatment in certain types of bone sarcoma (Ewing sarcoma and primary reticulum cell sarcoma of bone). Until recently, chemotherapeutic agents have been used for late palliation only. Advances in treatment, however, have resulted from the application of innovative postsurgical adjuvant chemotherapy in children. The various chemotherapeutic regimens following amputation in adults and in children are discussed. In most such series of cases following amputation alone, five-year survivals have not exceeded 15-20%, with recurrent disease appearing within 18 months in fatal cases. Current studies reflect more effective regimens of adjuvant chemotherapy, with improved palliative results in metastatic osteogenic sarcoma. Although survival is much prolonged, however, many patients show a recurrence of the disease after long intervals of control, suggesting that five-year survival may not indicate a complete cure. At M.D. Anderson Hospital, th projected overall survival rate at three years is 79% of all patients with nonmetastatic disease. These results have accrued from the use of Compadri-I and Compadri-II regimens of chemotherapy. More intensive therapy may yield higher survival rates. It is known that the immunologic status of a patient definitely relates to prognosis. Although most of the investigations with immunotherapy are preliminary, emphasis is placed on improving the immune system in immunodeficient patients.