Link and colleagues tested whether intensive combination chemotherapy given after definitive surgery improves relapse‑free survival in nonmetastatic high‑grade osteosarcoma of the limbs, compared with concurrent untreated controls.
Multi‑institutional randomized trial of 36 patients after definitive surgery, plus 77 who declined randomization and chose a treatment. Median follow‑up was about 2 years.
Methods
Design
Multicenter randomized controlled trial
Parallel cohort of patients who declined randomization
Setting
Multi‑institutional
Patients
156 registered, 113 eligible
Nonmetastatic high‑grade extremity osteosarcoma after definitive surgery
Among randomized patients, 2‑year actuarial relapse‑free survival was 66% with chemotherapy vs 17% with observation (p < 0.001).
The 77 patients who declined randomization showed the same pattern, with 2‑year relapse‑free survival of 67% on chemotherapy vs 9% on observation.
Surgery alone matched the historical natural history: 50% of patients recurred within 6 months, and more than 80% relapsed overall.
Overall survival did not yet differ significantly between groups at a median follow‑up of about 2 years.
Hematologic toxicity was the most common toxic effect: severe in 33% of treated patients and life‑threatening in another 16%.
Fewer than one third of eligible patients (36 of 113) agreed to be randomized.
Board pearl
About 80% of patients with localized limb osteosarcoma treated by surgery alone relapse, which earlier studies attributed to subclinical metastases already present at diagnosis.
Authors' conclusion
We conclude that the natural history of osteosarcoma of the extremity has remained stable over the past two decades, that adjuvant chemotherapy increases the chances of relapse-free survival of patients with high-grade osteosarcoma, and that it should be given to all such patients.
Link and colleagues tested whether intensive combination chemotherapy given after definitive surgery improves relapse‑free survival in nonmetastatic high‑grade osteosarcoma of the limbs, compared with concurrent untreated controls.
Multi‑institutional randomized trial of 36 patients after definitive surgery, plus 77 who declined randomization and chose a treatment. Median follow‑up was about 2 years.
Methods
Design
Multicenter randomized controlled trial
Parallel cohort of patients who declined randomization
Setting
Multi‑institutional
Patients
156 registered, 113 eligible
Nonmetastatic high‑grade extremity osteosarcoma after definitive surgery
Among randomized patients, 2‑year actuarial relapse‑free survival was 66% with chemotherapy vs 17% with observation (p < 0.001).
The 77 patients who declined randomization showed the same pattern, with 2‑year relapse‑free survival of 67% on chemotherapy vs 9% on observation.
Surgery alone matched the historical natural history: 50% of patients recurred within 6 months, and more than 80% relapsed overall.
Overall survival did not yet differ significantly between groups at a median follow‑up of about 2 years.
Hematologic toxicity was the most common toxic effect: severe in 33% of treated patients and life‑threatening in another 16%.
Fewer than one third of eligible patients (36 of 113) agreed to be randomized.
Board pearl
About 80% of patients with localized limb osteosarcoma treated by surgery alone relapse, which earlier studies attributed to subclinical metastases already present at diagnosis.
Authors' conclusion
We conclude that the natural history of osteosarcoma of the extremity has remained stable over the past two decades, that adjuvant chemotherapy increases the chances of relapse-free survival of patients with high-grade osteosarcoma, and that it should be given to all such patients.