EXTREMITY AND NON-EXTREMITY HIGH-GRADE OSTEOSARCOMA - THE NORWEGIAN-RADIUM-HOSPITAL EXPERIENCE DURING THE MODERN CHEMOTHERAPY ERA

Of 103 patients with high-grade osteosarcoma, 27% had tumours localize d outside the extremities. Non-extremity patients were significantly o lder at diagnosis than patients with extremity tumours (median 38 vs. 17 years). More than 90% of patients with extremity tumours received a dequate treatment (aggressive chemotherapy plus at least marginal surg ery), compared with only 25% of patients with non-extremity tumours. F ailure of adequate treatment was due to inoperable tumour, intralesion al surgery and age preventing aggressive chemotherapy. There was a hig hly significant difference in both local tumour control and overall su rvival, both favouring patients with extremity tumours, Within the ext remity tumour group, patients who were treated in prospective multicen tre trials had a significantly better outcome than non-trial patients. Our results show that the fraction of patients with high-grade tumour s that fall outside trials designed for 'classical osteosarcoma' may b e larger than is usually acknowledged, and that the results reported f or the classical group are by no means representative of the whole pat ient population. Improved and new treatment approaches are needed for patients with non-extremity tumours, particularly in the older age gro ups.