Combined treatment of osteosarcoma of the spine.

We reviewed the clinical features and results of treatment in 24 patients with osteogenic sarcoma of the spine treated over a 35-year period. There were 14 male and 10 female patients 13 to 71 years old. The tumor arose de novo in 13 patients and was secondary to other conditions in 11. All patients presented with pain, and 16 (67%) had neurological deficits. Patients were divided into two treatment groups. Thirteen patients treated from 1949 to 1977 usually underwent limited tumor resection and external radiation therapy. The second group, 11 patients treated from 1978 to 1984, underwent more aggressive surgical resection and received combination chemotherapy as well as local radiation to the tumor bed. In the second group, there were 5 long term survivors, and only 1 patient developed metastatic disease while on therapy. Failure to obtain local control was the major cause of treatment failure. Complete surgical resection of the tumor by spondylectomy and combination chemotherapy offer the best prospect for cure of osteogenic sarcoma of the spine.