Adjuvant Chemotherapy of Osteogenic Sarcoma and Surgical Resection of Pulmonary Metastases

Abstract

Adjuvant chemotherapy of osteogenic sarcoma can be viewed as a test case for the validity of the matched historical control as a clinical research tool in oncology. The positive case that can be made for the value of adjuvant chemotherapy rests entirely on historically-controlled data and as such its biologic significance is still open to serious question. While it is true that a prospective randomized trial was not needed to establish the value of penicillin for the treatment of pneumococcal pneumonia, adjuvant chemotherapy is not penicillin. The value of improving the two-year relapse-free survival (RFS) from 20% to 50–60% in patients with osteogenic sarcoma would be great but such differences, to be meaningful, require the discipline of a randomized trial with adequate numbers. Such data do not exist at this time. Historical controls do exist, however, which show a 20% RFS at two years and small single arms series which show a two-year RFS of 50–60%. The only prospective randomized trial which has been carried out shows that RFS after surgery and after surgery plus adjuvant chemotherapy is not significantly different and that surgery alone is significantly superior to earlier historical controls. Therefore, the value of adjuvant chemotherapy must be viewed as unproven and still open for clinical investigation.