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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2002 December;53(4):205-18
Chemotherapy of osteosarcoma
Ferrari S., Bacci G.
Chemotherapy and complete surgical removal of the tumor is the standard treatment for patients with osteosarcoma. Due to the rarity of the disease and to the reduced number of randomized clinical studies, standard chemotherapy combination is not defined yet. High dose methotrexate, cisplatin, doxorubicin and ifosfamide are the most effective, and more commonly used drugs for osteosarcoma. Non controlled clinical studies showed that the best oncologic results were achieved when all the four drugs were used, but these observations have not been confirmed by randomized clinical studies. Primary chemotherapy and delayed surgery followed by adjuvant chemotherapy is the strategy of treatment usually adopted, but there is no evidence that such strategy was better, in terms of disease-free survival, than immediate surgery and adjuvant chemotherapy. Since the histologic response to primary chemotherapy is a prognostic factor, in some trials the drugs used in the postoperative treatment were modified according to the primary chemotherapy induced tumor necrosis (salvage chemotherapy). There is no agreement on the effectiveness of this strategy of treatment. Standard treatment in patients with recurrent osteosarcoma is the surgical removal of recurrence. There is no agreement on the effectiveness of second-line chemotherapy, and also the use of high dose chemotherapy treatment and PBSC rescue showed disappointing results. Patients with metastatic osteosarcoma are treated with the same drugs used for localized patients, but their prognosis is worse even if they undergo complete surgery.