Chemotherapy for Advanced Osteogenic Sarcoma and Ewing’s Sarcoma

Abstract

Malignant bone and cartilage tumors account for less than l% of all malignant neoplasms. Osteogenic sarcoma is the most common primary malignant neoplasm of bone, most frequently occurring in the diaphysis, especially in the femur. The incidence of osteogenic sarcoma peaks between ten and 25 years of age. Although many of the patients with osteogenic sarcoma present with clinically localized disease, the five-year survival rate for osteogenic sarcoma achieved with local treatment alone (surgical excision or amputation, radiation therapy, or both) is only about 20%. Preoperative radiation and surgery does not improve survival over surgery alone. In 1972, Friedman and Carter reviewed 17 reported series of patients with osteosarcoma and found a five-year survival ranging from 16–23% (Friedman and Carter, 1972). Some have suggested that the five-year disease-free survival after surgery alone has been raised to 50% (Carter and Friedman, 1978; Taylor et al, 1978). This has, however, been disputed and the figure of 20% remains generally accepted (Gehan et al, 1978; Mike and Marcove, 1978). The 10-year survival after surgery alone is 16% so that most patients who survive to five years may be regarded as cured. The natural history of osteogenic sarcoma does not appear to have changed over the past several decades (Mike and Marcove, 1978; Jaffe et al, 1974; Harvei and Solheim, 1981). The mean time to the appearance of pulmonary metastases — the most common metastases — after surgery is 10 months (Friedman and Carter, 1972). Before the 1970’s, the average time between the recognition of pulmonary metastases and death was six months (Friedman and Carter, 1972). These survival and natural history variables provide consistent clean end points which may be used in judging the effectiveness of new therapies for osteogenic sarcoma. The rapid clinical appearance of distant metastatic disease has led many clinical investigators to conclude that most patients present with distant micrometastases which are not clinically evident at the time of their initial diagnosis. It is therefore expected that these patients will fail when given local therapy only.