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Summary
In the last years, the treatment of patients with osteosarcoma of the members underwent a great evolution. Chemotherapy with adriamycin and high-dose metho-trexate-citrovorum rescue has considerably increased the remission rate in generalized osteosarcoma. The use of these drugs as consolidation therapy after radical resection of the primitive tumor has resulted in a prolongation of the survival and probably in a greater number of definitive cure. For many years now osteosarcoma is considered as a generalized disease from the early diagnosis. Radical treatment of the primitive tumor remains the essential approach to treatment but more recently resection followed by a total replacement of bone by a metallic prothesis with conservation of the affected member seems to gain in importance in comparison with radical amputation. Cytotoxic drugs should be administered early in the disease course. The usefulness of immunotherapy, actually under thorough investigation, is not proven until now.
In generalized cases, chemotherapy together with radiotherapy of primitive or secondary bone lesions remain the most interesting treatment approach. Surgical resection of lung metastases can be of benefit in selected cases.
Nevertheless, all therapeutic approach to the patient suffering from osteosarcoma should be multidisciplinary with the aim of definitive cure and with, whenever possible, preservation of the limb.