Treatment results of pediatric osteosarcoma: twenty-year experience.

The objectives of the study were to compare the results of surgical procedures, amputation and limb-sparing surgery, and to assess the influence of preoperative chemotherapeutic regimens on the survival of pediatric patients with osteosarcoma. We retrospectively analyzed 69 patients treated at our institution between January 1985 and April 2004. The primary treatment modalities were limb-sparing surgery or amputation with or without preoperative chemotherapy. The need for postoperative chemotherapy was determined by the histological response, the tumor margins, and the burdens created by the metastatic disease. The age range was 5.3 to 18.6 years (median, 13.3 years); with a male-female ratio of 0.9. The most common lesion site was the femur, found in 39 patients. Fourteen of the patients had metastases involving the lungs or other bones at the time of diagnosis. Preoperative chemotherapy was done in 45 patients. Most of the patients were treated with cisplatin + adriamycin (27/69, 39.1%). Forty-two patients were surgically treated by amputation and 19 with limb-sparing surgery. Four patients had surgical resection of masses located at sites other than the extremities, and in 4 patients, surgery was not possible. The overall survival rate for the whole group was 32.6%. The overall survival rates were 27.2% and 66.9% for the patients treated with amputation and limb-sparing surgery, respectively. Osteosarcoma has a poor prognosis. Based on our 20-year experience, limb-sparing surgery as surgical management and the cisplatin + adriamycin preoperative chemotherapy regimen seem to be a promising modality for the patients with osteosarcoma.