Metastatic osteosarcoma: a review of current issues in systemic treatment.

Purpose. Original articles and abstracts published between January 1991 and January 1997 were selected according to specified criteria and reviewed to provide answers to five interesting questions about the systemic treatment of metastatic osteosarcoma.Results.(1) In patients with metastatic disease at presentation, what is the outcome after intensive multi-agent chemotherapy?Historically, survival has been poor, but may be improving with the use of ifosfamide-containing regimens.(2) Can response to new agents be evaluated better in patients who have received no previous chemotherapy?Based on limited data, this is probably true.(3) Is the response to neo-adjuvant chemotherapy, as determined by histopathology, similar for the primary tumor and synchronous pulmonary metastases?With intensive multi-agent chemotherapy, good histological response rates are in the range 70-90% for both groups.(4) What is the outcome, after intensive combined modality treatment with chemotherapy and surgery, in patients relapsing with metastases after previous adjuvant chemotherapy, and what are the important prognostic factors?Outcome is highly variable, but 5-year survival ranges between 25 and 50% and a good outcome is more likely if recurrent disease is limited to resectable lung metastases.(5) Can a biological agent (L-MTP-PE) prolong the time to relapse in patients with resected metastatic osteosarcoma?Preliminary data suggest that this is possible, but more studies are required.