This prospective COSS cohort study enrolled 1,702 consecutive patients with high-grade osteosarcoma treated on neoadjuvant protocols from 1980–1998. It identifies independent predictors of chemotherapy response and long-term survival across the full disease spectrum — not just the typical young patient with localized extremity disease. At 1,702 patients, it remains the largest such cohort from the polychemotherapy era.
The two things you can influence most in osteosarcoma are surgical margins and chemotherapy response — and this paper quantifies exactly what is at stake with each.
When counseling a patient with axial osteosarcoma, set realistic expectations: 10-year survival is 29.2%, driven almost entirely by inability to achieve local control. Aggressive multimodal therapy is still warranted, but the obstacle is surgical, not systemic.
When a patient presents with primary metastatic disease, do not abandon a curative approach. Complete resection of all sites. Primary and metastatic. Yields 40.3% 10-year survival. The authors argue experimental upfront therapy is not justified when aggressive standard surgery remains achievable.
The Salzer-Kuntschik grading system is the standard tool for assessing histologic response after neoadjuvant chemotherapy. Knowing the grade after resection tells you prognosis and guides postoperative chemotherapy decisions. A grade 6 patient (32.7% 10-year OS) needs a different conversation than a grade 1 patient (81.3%).
This prospective COSS cohort study enrolled 1,702 consecutive patients with high-grade osteosarcoma treated on neoadjuvant protocols from 1980–1998. It identifies independent predictors of chemotherapy response and long-term survival across the full disease spectrum — not just the typical young patient with localized extremity disease. At 1,702 patients, it remains the largest such cohort from the polychemotherapy era.
The two things you can influence most in osteosarcoma are surgical margins and chemotherapy response — and this paper quantifies exactly what is at stake with each.
When counseling a patient with axial osteosarcoma, set realistic expectations: 10-year survival is 29.2%, driven almost entirely by inability to achieve local control. Aggressive multimodal therapy is still warranted, but the obstacle is surgical, not systemic.
When a patient presents with primary metastatic disease, do not abandon a curative approach. Complete resection of all sites. Primary and metastatic. Yields 40.3% 10-year survival. The authors argue experimental upfront therapy is not justified when aggressive standard surgery remains achievable.
The Salzer-Kuntschik grading system is the standard tool for assessing histologic response after neoadjuvant chemotherapy. Knowing the grade after resection tells you prognosis and guides postoperative chemotherapy decisions. A grade 6 patient (32.7% 10-year OS) needs a different conversation than a grade 1 patient (81.3%).