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Prilozi. 2008 Dec;29(2):309-23.

Treatment of non-metastatic high-grade osteosarcoma (study of 30 cases treated with Scandinavian osteosarcoma protocol XIV and surgery).

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  • 1Musculoskeletal Tumours Department, University Orthopaedic Surgery Clinic, Ss. Cyril and Methodius University, Skopje, R. Macedonia.


The aim of this study is to improve 3-years survival rates and functional outcome in high-grade osteosarcoma patients treated with amputations and limb-sparing surgery, introducing Scandinavian Sarcoma Group chemotherapy protocol (SSG XVI).


During the period 2000-2005, thirty seven patients with high-grade, non-metastatic osteosarcoma on the extremities were treated at the Clinic for Orthopaedic Surgery in Skopje. Mail patients were 21 (57%) and female were 16 (43%). Patients age varied from 8 to 63 years (mean 18 +/- 13). Seven patients (7/37) did not comply with including criteria and were excluded from the study. The rest 30 patients were introduced to two courses of pre-operative chemotherapy (high doses of Methotrexate, Cisplatin and Adriamycin). Surgical treatment was in 9-th week of the protocol. In 27/30 (90%) of the patients limb-sparing surgery was done, and in 3/30 (10%) amputations were performed. Histopathological assessment of the tumour after the neo-adjuvant chemotherapy divided the patients into group with bad and group with good response. All the patients had 3 more courses of chemotherapy after surgery (same as the preoperative). Patients with bad response were introduced to 3 more cycles of 5 days with high-dose of Ifosfamide. Follow-up was from 2 to 8 years, mean 51 months.


Histopathological assessment showed that 57% of the patients had bad response to neo-adjuvant chemotherapy, but there was no statistical significance in the survival time of the groups (p = 0.06). Three-years survival time was 40% of the patients with local recurrence in comparison with 80% of the patients with no local recurrence. Three-years survival time was 20% of the patients with distant metastases in comparison with 92% of the patients with no metastases. Overall survival time (OS) was 80%. After 3 years 60% of the patients were disease-free (DFS).


High-grade osteosarcoma of the extremities treated with modern chemotherapy protocols enables limb-sparing in the same time with improved survival time of the patients. Introducing high-dose Ifosfamide in treatment of patients with bad response after neo-adjuvant chemotherapy improves their functional results as well as the survival time. Key words: osteosarcoma, neo-adjuvant chemotherapy, limb-sparing.

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