Chemotherapy for malignant bone tumors.

Chemotherapy has had a major impact in malignant bone tumors. In osteosarcoma, metastasis-free survival has been achieved in approximately 50 to 75 per cent of patients. Additional improvement based on the altered pattern of pulmonary metastases has also been reported. Preoperative chemotherapy has facilitated surgical resection of the primary tumor. The effects on the primary tumor may be utilized as a predictive factor and to design postoperative adjuvant therapy. Similar results have been achieved in Ewing's sarcoma with survival rates in the vicinity of 50 to 80 per cent. The interaction of chemotherapy with radiation has augmented the ability to achieve local control of the primary tumor. The tumoricidal properties of chemotherapy in destroying micrometastases may possibly also contribute to local control. Finally, initial treatment with chemotherapy may yield a complete response and facilitate definitive surgical treatment of the primary tumor. This may eliminate the need for radiation therapy and its delayed consequences.