A strategic adjuvant therapy of osteosarcoma

Twenty-one patients with osteogenic sarcoma of the limbs were treated with an early combination of 1,750 rad whole lung irradiation, alternate cyclic chemotherapy with high-dose methotrexate, vincristine, mitomycin C, adriamycin, immidazol carboxamide (DTIC), cyclophosphamide, and intercalated immuno-BCG. The primary lesion was treated either by amputation or an 8,000 rad irradiation. Patients have been followed up for 6-29 months. Three patients relapsed, respectively, after 8, 11, and 22 months. All three patients had a long delay in completing the first part of treatment (first cycles A and B and lung irradiation). The 18 other patients are disease-free. Local relapses have not been observed. The toxicity of this protocol appears to be acceptable, but a longer follow-up is necessary to more precisely discern the efficacy and tolerance of the lung to this combined treatment.