Recognition and treatment of osteosarcoma in the military health care system

Forty-two patients with high-grade intramedullary osteosarcoma treated at Walter Reed Army Medical Center between 1985 and 1995 were reviewed to determine what effects military "managed health care" had on diagnosis, treatment, and outcome. Five-year survival was 61% overall (SE +/- 9.9%), despite local disease control obtained in 95% of patients. There was a statistically significant difference between active duty members and dependents in time to diagnosis (p = 0.008), yet there was no significant difference in survival between the two groups. Five-year survival in our patient population was slightly lower than 5-year survival reported in some large civilian medical centers despite good local disease control and intensive multiagent chemotherapy. Delays in diagnosis and military status had no apparent effect on survival, although limb salvage was not possible in nearly 40% of patients because of tumor size, disease extent, and involvement of neurovascular structures.