LONG-TERM RESULTS OF THE COOPERATIVE GERMAN-AUSTRIAN-SWISS OSTEOSARCOMA STUDY-GROUPS PROTOCOL COSS-86 OF INTENSIVE MULTIDRUG CHEMOTHERAPY AND SURGERY FOR OSTEOSARCOMA OF THE LIMBS

Background: In an effort to intensify osteosarcoma. therapy, systemic ifosfamide was added pre- and postoperatively to an already aggressive three-drug regimen. In a subgroup of patients, loco-regional treatmen t intensification was attempted by using the intraarterial route to gi ve cisplatin. Patients and methods: Patients less than or equal to 40 years at diagnosis of a localised, de novo high-grade central extremit y osteosarcoma were eligible for inclusion into study COSS-86 if regis tered within three weeks from biopsy. Doxorubicin, high-dose methotrex ate, and cisplatin were given to all patients. Patients who fulfilled one or more of three defined high-risk criteria received early systemi c treatment intensification by adding ifosfamide as the fourth agent. Preoperatively, these high-risk patients received cisplatin either int raarterially or intravenously. Results: 171 eligible patients were ent ered, of which 128 were stratified into the high-risk group. When all 171 were analysed by intention-to-treat, actuarial overall and event-f ree survival rates at ten years were 72% and 66%, respectively. No ben efit of intraarterial cisplatin application was detected. Cumulative t reatment toxicity was considerable. Conclusions: In a multicenter sett ing, intensive treatment of osteosarcoma according to protocol COSS-86 led to long-term disease-free survival for two thirds of patients. We saw no benefit of using the intraarterial route to administer cisplat in.