Osteosarcoma of the extremities metastatic at presentation: Results obtained with primary chemotherapy followed by simultaneous resection of the primary and metastatic lesions

From September 1986 to September 1988 10 patients affected by osteosarcoma of the extremities with metastases at presentation were treated by chemotherapy (two cycles of high-dose methotrexate i.v. - cisplatinum i.a. - adriamycin i.v.) followed by simultaneous resection of the primary and metastatic tumor. A complete histological examinatiaon of the resected specimens was always performed to evaluate the percentage of necrosis produced by chemotherapy on both the primary and metastatic tumors. After surgery the patients received 3 more cycles of the same drugs as used preoperatively plus ifosfamide. The histological response of tbe primary tumor was 'good' (90% or more tumor necrosis) in 4 patients and 'poor' (less than 90% of tumor necrosis) in 6, while in the 33 metastatic lesions the resulting necrosis was good in 8 and poor in 25. In the 4 patients with good response of the primary tumor the histological response was also good in 6 of the 11 metastatic lesions (54%) while in the 6 patients with poor response of the primary tumor only two of the 22 metastatic lesions (9%) showed a good histological response. At an average follow-up of 28 months, only 2 patients out of 10 are alive and disease-free. These data suggest that in osteosarcoma of the extremities metastatic at presentation, even with a very aggressive treatment the prognosis remaines poor. Our results also seem to confirm the validity of the strategy largely used today of neoadjuvant postoperative chemotherapy in the patients responding poorly to preoperative treatment.