Adjuvant chemotherapy for osteosarcoma may not increase survival after neoadjuvant chemotherapy and surgical resection

Background and Objectives: Osteosarcoma is a primary malignancy of bone. Current therapy includes neoadjuvant chemotherapy, surgery, and postoperative (adjuvant) chemotherapy. Prolonged treatment with chemotherapeutic agents may place patients at increased risk for complications including secondary malignancy. The authors have had promising results with neoadjuvant therapy and surgery alone in the treatment of osteosarcoma. This study retrospectively examines neoadjuvant therapy and surgery alone for the treatment of primary osteosarcoma of bone with no evidence of distant metastases. Methods: Fifty-four patients, with localized osteosarcoma. of bone received neoadjuvant therapy followed by definitive surgical resection. Thirty-five patients received chemotherapy after surgery (adjuvant group) and nineteen patients were followed without postoperative chemotherapy (no adjuvant group). Results: Tumor necrosis was predictive of survival. Kaplan-Meier analysis revealed the use of postoperative chemotherapy was not a predictor of improved outcome. Four patients in the adjuvant therapy group died of secondary malignancy compared with none of the no adjuvant therapy group. Patient age, sex, race, and tumor location were not predictive of survival. Conclusions: The use of adjuvant chemotherapy in the treatment of localized osteosarcoma of bone did, not increase survival after neoadjuvant therapy and definitive surgical therapy. Instead, there was an increased incidence of secondary malignancy after its use. (C) 2001 Wiley-Liss, Inc.