| Abstract: |
Successful treatment for osteosarcoma (OS) requires the combination of effective systemic chemotherapy and surgical resection of all sites of clinically detectable disease. Prior to the introduction of systemic chemotherapy, patients who presented with OS of the extremity without clinically detectable metastatic disease underwent immediate surgical resection of the primary tumor. Five-year survival rates using this approach ranged from 11 to 25% (Anninga et al. 2011). In the early 1970s, trials evaluated OS response to single agents including high-dose methotrexate (HDMTX) with leucovorin rescue, cisplatin (CDDP), and doxorubicin (DOX) (Table 7.1) (Anninga et al. 2011; Pratt and Shanks 1974). Several studies reported that single agent or combination chemotherapy administered to patients with OS after primary tumor resection resulted in improved survival compared to historical controls (Anninga et al. 2011). Other reports suggested that the apparent improvement in outcome was related to improvement in diagnosis and surgery rather than a benefit from adjuvant chemotherapy (Carter 1984; Taylor et al. 1985). Two randomized prospective trials subsequently confirmed the benefit of adjuvant chemotherapy following resection of primary OS (Eilber et al. 1987; Link et al. 1986). Trials evaluating regimens including doxorubicin and high-dose methotrexate or doxorubicin and cisplatin following resection of the primary tumor reported 3- to 5-year event-free survival ranging from 50 to 60% or more in patients who presented without clinically detectable metastases (Anninga et al. 2011; Ettinger et al. 1981; Goorin et al. 1987; Pratt et al. 1990). In the 1980s, several investigations established the activity of ifosfamide or ifosfamide and etoposide in recurrent and metastatic OS (Harris et al. 1995; Miser et al. 1987). © Springer Nature Switzerland AG 2021. |
