[Results of treatment in primary disseminated osteosarcoma. Analysis of the follow-up of patients in the cooperative osteosarcoma studies COSS-80 and COSS-82]. / Behandlungsergebnisse bei primär disseminiertem Osteosarkom. Verlaufsanalyse von Patienten aus den cooperativen Osteosarkom-Studien COSS-80 und COSS-82.

Since the long-term disease-free survival rate in adjuvantly treated osteosarcoma has nowadays reached a level of about 70%, increasing interest is also being directed towards primarily disseminated forms of the disease. Primary metastases, which were confined to the lungs in 42 cases, were detected in 59 out of 421 patients from the prospective therapy trials COSS-80 and COSS-82. The primary tumors were more frequently localized in the proximal femur and flat bones as compared to patients without detectable metastases at diagnosis. Following chemotherapy and surgery of the primary tumor, 15/31 (48%) patients whose metastases were excised have survived for 4-8 years, in contrast to only 1/22 (5%) of those patients whose metastases could not be removed for a variety of reasons. Clinical or histological evidence of tumor response after primary chemotherapy significantly influenced the outcome of the metastasectomized patients.

[Results of the COSS-77 and COSS-80 studies on adjuvant chemotherapy in osteosarcoma of the extremities]. / Ergebnisse der Studien COSS-77 und COSS-80 für die adjuvante Chemotherapie bei Osteosarkom der Extremitäten.

In the first study, COSS-77, 100 patients with OS were treated for 12 months according to a CT-protocol consisting of high-dose methotrexate (HD-MTX), adriblastine (ADR) and cyclophosphamide (CP). At 40 months the expected continuous disease-free survival (CDFS) rate of the 71 evaluable patients was 55%. After exclusion of local recurrences (n = 2) and fatal chemotherapy toxicities (n = 0) a reduced group of 69 patients remained and the expected CDFS rate at 40 months became 56%. In the second study, COSS-80, the MTX dose was doubled. Two groups were randomly selected, one of which received cisplatinum (CPL) and the other the triple drug combination bleomycin + CP + dactinomycin (BCD) in addition to MTX and ADR, both groups being treated for 8 months. Furthermore some randomly selected patients received fibroblaste-interferon (IF). The expected CDFS rate at 40 months of the 115 evaluable COSS-80 patients was 67%. 106 patients remained in a reduced group defined as above (4 local recurrences and 5 CT toxicities) in which the expected CDFS rate at 40 months was 73%. This is significantly better (p less than 0.05) than the results obtained from the COSS-77 group. No differences were found between the CPL and BCD arms of the COSS-80 group or between the arms receiving or not receiving IF. A significant increase in the CDFS rate for young (less than 12 years) and male patients over that in COSS-77 was observed in COSS-80, probably due to the increased MTX dose.(ABSTRACT TRUNCATED AT 250 WORDS)