[The Zurich experience with preoperative high-dose methotrexate in osteosarcomas]

15 consecutive patients with osteosarcoma underwent preoperative chemotherapy with high dose methotrexate (HDMTX) containing regimens according to the T7 or T10 protocols of ROSEN, Preoperative chemotherapy was well tolerated and did not impair surgical procedures. 67% of the patients responded clinically with reduction of pain and tumor size. Histologic examination of the tumor after preoperative chemotherapy revealed extensive necrosis in 53% of patients. In a retrospective analysis, patients with extensive necrosis (group B) were compared with those with little or no necrosis (group A). Patients from group B had a longer relapse free and overall survival period than group A. In addition, patients of group A had significantly higher initial levels of alkaline phosphatase than group B. The incidence of a 2.5-fold increase of the transaminases 2-3 days after HDMTX was significantly greater in patients of group B compared to group A. In the absence of documented necrosis after chemotherapy according to the T7 or T10 protocols, further use of HDMTX is not indicated. New aspects on the treatment of osteosarcoma, derived from recent publications, are discussed.