IIB Osteosarcoma

Abstract

Three hundred and ninety-three patients with IIB osteosarcoma were treated at the author's institution between 1955 and 1986. In the first stage of the study, 88 patients were treated with surgery only. The five-year disease-free survival rate was 7%. In the second stage of the study, the efficacy of preventive chemotherapy after radical surgery was studied in 55 patients. The five-year disease-free survival rate was 34.4%. In the third stage of the study, the efficacy of combination therapy consisting of preoperative treatment, limb-saving surgery, and preventive chemotherapy was studied in 66 patients. The five-year disease-free survival rate was 35.5%. The authors examined results in 21 patients with Grade IV responses to evaluate the relationship between prognosis and morphogenic changes after preoperative radiotherapy and chemotherapy. The five-year disease-free survival rate was 57.9%. In the fourth stage of the study (conducted in 1986), two regimens of preoperative chemotherapy were initiated. The first regimen consists of intraarterial platinum infusions to patients with lower extremity bone damage. The second regimen consists of high-dose methotrexate infusions. The preliminary conclusion is that primary tumor damage is significantly more marked after intraarterial cisplatin infusion.Oncogenic sarcoma is the primary nosologic form of skeletal malignant tumors. Until recently, prognoses remained extremely unfavorable in patients with this disease. Experience has shown that methods limited to treatment at the primary tumor site do not prevent hematogenic metastatic spreading of the disease. The short interval between surgery and generalized metastatic spread implies the subclinical presence of the metastases. The authors' institution coordinates the development of modern methods of osteogenic sarcoma therapy in the USSR. The search for the most effective methods of osteogenic sarcoma therapy is ongoing in the musculoskeletal tumor clinic. Different approaches to osteosarcoma therapy have been studied for almost three decades. In addition to clinical trials, a critical analysis of the efficacy of therapy was conducted. As a result, several methods of treatment were chosen. Surgery remains the leading method of treatment for osteogenic sarcoma, either alone or in combined therapy.From 1955 until 1986, 393 patients with IIB osteosarcoma were treated at the authors' institution. Eighty-eight patients were treated with surgery only. In all cases, surgical intervention involved amputation and exarticulation of an extremity. The collected data demonstrates that the results of using surgery alone in osteosarcoma therapy are extremely unfavorable. Seventy-five and two-tenths percent of patients developed hematogenic metastases within one year after the operation. After three years, only 10. I% of patients were without metastases. The five-year metastasis-free survival of these patients was only 7% (Fig. 1).The last decade has been characterized by great progress in the treatment of osteosarcoma. The outlined posit...