Management of osteogenic sarcoma: a perspective based on the Mayo Clinic experience

We reviewed pertinent aspects of the Mayo Clinic experience with osteogenic sarcoma to place into perspective some of the recent advances in the management of patients with this tumor. Various histopathologic subtypes have been recognized and can be differentiated from the conventional or classic osteogenic sarcoma. Our experience indicated that, when appropriate, crossbone amputation provided adequate and effective surgical treatment. A controlled study in which pulmonary micrometastases were evaluated failed to demonstrate that prophylactic pulmonary irradiation after amputation conferred any therapeutic advantage. The use of combination chemotherapy or transfer factor did not improve disease-free survival when the results were compared with our recent experience with surgical treatment alone. Progressive improvement in disease-free and total survival was observed between 1963 and 1974, although we have been unable to relate this to the effects of adjuvant chemotherapy. Aggressive surgical excision of pulmonary metastatic lesions had a positive effect on total survival. These observations led us to conclude that carefully controlled studies are still needed to define more clearly the role of adjuvant chemotherapy in nonmetastatic osteogenic sarcoma. Although such a study is in progress at the Mayo Clinic, it is too early for any evaluation of the results.