The Effect of Adjuvant Chemotherapy on Relapse-Free Survival in Patients with Osteosarcoma of the Extremity

Abstract

We conducted a randomized controlled trial to determine whether intensive multi-agent adjuvant chemotherapy improves the chances of relapse-free survival in patients with nonmetastatic high-grade osteosarcoma of the extremity, as compared with concurrent controls. After undergoing definitive surgery, 36 patients were randomly assigned to adjuvant chemotherapy or to observation without adjuvant treatment. At two years the actuarial relapse-free survival was 17 percent in the control group, similar to that found in studies before 1970, and 66 percent in the adjuvant-chemotherapy group (P less than 0.001). Similar results were observed among 77 additional patients who declined to undergo randomization but who elected observation or chemotherapy. We conclude that the natural history of osteosarcoma of the extremity has remained stable over the past two decades, that adjuvant chemotherapy increases the chances of relapse-free survival of patients with high-grade osteosarcoma, and that it should be given to all such patients.

Development and external validation of nomograms predicting distant metastases and overall survival after neoadjuvant chemotherapy and surgery for patients with nonmetastatic osteosarcoma: A multi‐institutional study

“…The long‐term survival of osteosarcoma patients has improved dramatically because of the introduction of effective systemic chemotherapy 1, 2, 3, 4. Recent studies have demonstrated a more favorable outcome, especially for patients with nonmetastatic osteosarcoma 5, 6.…”

Intraoperative radiotherapy in the multidisciplinary treatment of bone sarcomas in children and adolescents

“…Contemporary survival rates in patients with localized disease have been reported in the range of 65-75% for Ewing's sarcoma [4][5][6][7] and 65-90% for osteosarcoma [8,9].…”

Bystander-mediated regression of osteosarcoma via retroviral transfer of the herpes simplex virus thymidine kinase and human interleukin-2 genes

“…6,7 Adjuvant and postoperative chemotherapy can reduce micrometastases and tumor size. 6,8,9 Nevertheless, 40% of all osteosarcoma patients experience relapse within 5 years, and relapse carries a 70% 5-year mortality rate. 9,10 Nearly 30% of relapsing patients develop lung metastasis within the first year, and the 2-year survival rate for metastatic osteosarcoma is Յ30%.…”

“…6,8,9 Nevertheless, 40% of all osteosarcoma patients experience relapse within 5 years, and relapse carries a 70% 5-year mortality rate. 9,10 Nearly 30% of relapsing patients develop lung metastasis within the first year, and the 2-year survival rate for metastatic osteosarcoma is Յ30%. 9,11 The obstinate clinical course of osteosarcoma despite aggressive standard therapy demands the investigation of new treatment approaches.…”

“…9,10 Nearly 30% of relapsing patients develop lung metastasis within the first year, and the 2-year survival rate for metastatic osteosarcoma is Յ30%. 9,11 The obstinate clinical course of osteosarcoma despite aggressive standard therapy demands the investigation of new treatment approaches. A promising method is to impart cancer cells with sensitivity to ganciclovir (GCV) by retroviral delivery of the herpes simplex virus thymidine kinase (HSVtk) gene.…”