[New therapeutic results in osteosarcoma]

Primary systemic chemotherapy and delayed surgery, if it is surgically feasible with preservation of the limb, has produced better results in osteogenic sarcomas than primary surgery with loss of time due to the postoperative therapy free interval. Histologic examination of the resected tumor determines the effect of preoperative chemotherapy and identifies patients at high risk. These patients not having a favorable effect on preoperative chemotherapy can be placed on an alternative postoperative regimen before relapsing clinically. These earlier changes of chemotherapeutic strategy in patients with histologically proven ineffective chemotherapy has yielded further improvement in treatment results in patients with osteogenic sarcomas with a 93% disease free survival (median 20 months) to date using an individualized taylored treatment approach at the Memorial Sloan Kettering Cancer Center/New York. Now that effective chemotherapy is available for many other malignant tumors this model of "neo-adjuvant" chemotherapy could also serve as a model for the treatment of other highly malignant tumours.