Grade of chemotherapy-induced necrosis as a predictor of local and systemic control in 881 patients with non-metastatic osteosarcoma of the extremities treated with neoadjuvant chemotherapy in a single institution

Gaetano Bacci, Mario Mercuri, Alessandra Longhi, Stefano Ferrari, Franco Bertoni, Michela Versari, Piero Picci

Research output: Contribution to journalArticle


To determine whether necrosis induced by pre-operative chemotherapy correlates with the rate of systemic and local relapse, may change the pattern of relapse and/or may modify the chance of success of post-relapse treatments, we evaluated 881 patients with non-metastatic osteosarcoma of the extremities treated with five different protocols of neoadjuvant chemotherapy and surgery at the same institution between 1983 and 1999. The 5-year disease-free survival (DFS) and overall survival (OS) correlated significantly with the histological response to chemotherapy. Five-year DFS and OS in good and poor responders were 67.9% versus 51.3% (P <0.0001) and 78.4% versus 63.7% (P <0.0001), respectively. The prognostic value of the histological response was valid only for osteoblastic and telangiectatic osteosarcoma subtypes. Nonetheless, since they represent more than 70% of all osteosarcomas, we conclude that chemotherapy-induced necrosis has a significant prognostic value, regardless of the type of chemotherapy performed after surgery.

Original languageEnglish
Pages (from-to)2079-2085
Number of pages7
JournalEuropean Journal of Cancer
Issue number14
Publication statusPublished - Sep 2005



  • Chemotherapy
  • Necrosis
  • Osteosarcoma
  • Prognosis

ASJC Scopus subject areas

  • Cancer Research
  • Hematology
  • Oncology

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