The pathologist's role in the diagnosis and treatment of osteosarcoma in children.

Tumor specimens from 24 children under 15 years of age were studied. The children had osteosarcoma and received intra-arterial infusions of cis-platinum before resection or amputation. There were 13 boys and 11 girls, and the median age was 12 years. Fifteen lesions were located in the femur, four in the humerus, three in the tibia, one in the pubis, and one in the radius. Sixteen patients underwent diagnostic needle biopsies and the remainder, open biopsies. Eleven patients had excellent tumor response, with over 90 per cent tumor destruction in six and 65 to 75 per cent in five. One patient had 50 per cent tumor destruction, and in nine patients the response was insignificant. Two patients had good clinical responses to treatment and refused limb amputation; one additional patient died of the disease without amputation or resection. The systematic study of pathology specimens is being undertaken to determine the utility of such a study as a guide to the selection of adjuvant chemotherapy. Patients in whom no responses are obtained should receive alternative treatment, and those in whom responses are optimal should retain the original agent in their adjuvant chemotherapy regimen.