Overall results of adjuvant chemotherapy and a chemosensitivity test for osteosarcoma.

Among 59 patients with long bone osteosarcoma without metastases at first diagnosis, the five-year cumulative survival rate was 51.7% following surgery and chemotherapy, and 14.4% in an historical control group. Preoperative combination chemotherapy with high-dose methotrexate, adriamycin, and vincristine was found to be effective in 60% (9/15) of the patients. Histopathological examination of the resected tumor indicated a necrosis rate of over 90%. Twenty tissue samples from 12 patients were tested for sensitivity to anticancer drugs using the human tumor clonogenic assay. Samples obtained by biopsy from four of five patients were found to be sensitive to methotrexate or cisplatin, as were five of six surgical specimens from primary lesions. Samples from pulmonary metastases, however, were either resistant or showed poor sensitivity to all anticancer agents tested. The predictability for methotrexate was 87.5% (7/8). Results indicate that combination chemotherapy improves patient survival. Further improvement in the overall prognosis may be achieved by using a reliable tumor sensitivity test to prepare an optimal chemotherapy program.