Adjuvant multiple drug chemotherapy for osteosarcoma of the extremity: a 6 year report.

Fifty-five cases of osteosarcoma of the extremities were treated between 1972 and 1976 with combination surgery and polychemotherapy (vincristine, adriamycin and methotrexate at medium doses) for 18 months. Their follow-up presently ranges between 30 and 80 months (mean = 48 months). Twenty-six patients remained free from disease signs, 2 showed local recurrence but no metastases, and 27 exhibited metastases (4 of these also had local recurrences). In 12 patients, the metastases appeared after the end of chemotherapy. Both metastases and local recurrences were more frequent in those patients submitted to segmental bone resection (7/8) than in those treated by more radical surgery (22/47). Comparison with a historical group (94 osteosarcoma patients treated with surgery alone at our Institute between 1960 and 1971) revealed that, during the follow-up period considered, the percentage of patients free from disease signs was higher in the group that also received chemotherapy. In addition, in this group metastatic appearance was delayed (mean = 15 months) as compared to historical controls (mean = 8 months). On the other hand, after the same kind of surgery, the rate of local recurrences and the time of their appearance was practically the same in both groups.