Preoperative (neoadjuvant) chemotherapy for osteogenic sarcoma: a ten year experience.

During the past ten years, (November 1973 through November 1983) 208 patients with fully malignant primary osteogenic sarcoma of an extremity were treated with preoperative chemotherapy on four successive treatment protocols. Continuous improvements in the disease-free survival of patients were attributed to refinements in the chemotherapy regimens. These refinements were made after direct observation of the response of the primary tumor to chemotherapy. At a minimum follow-up time of 36 months for 87 patients treated on the T-10 chemotherapy protocol, 67 (77%) have remained alive and continuously free of disease, and 71/87 (81.6%) are currently free of disease. Of the entire group of 208 patients receiving preoperative chemotherapy, 150 (72%) have remained continuously free of disease, and 158/208 (76%) are currently free of disease from three to 11 years (median five years). The overall complete response rate of the primary tumor to preoperative chemotherapy was 49%. Relapses in 19 patients with tumors about the knee were attributed to local recurrences following en bloc resection. Of the 58 patients undergoing amputation following preoperative chemotherapy, 46/58 (79.3%) have remained alive and continuously free of disease. 23/25 patients (92%) having undergone resection for proximal humerus lesions remain alive and free of disease at this time. There have been no local recurrences for patients having humeral resections. Preoperative chemotherapy has given rise to better chemotherapy regimens, higher cure rates, and the appropriate selection of the best postoperative therapy for patients with osteogenic sarcoma.