Neoadjuvant Chemotherapy for Osteogenic Sarcoma: A Model for the Treatment of Other Highly Malignant Neoplasms

Abstract

The term “neoadjuvant chemotherapy” was first described by Frei in his Karnofsky lecture, where it was used to describe the use and benefits of preoperative chemotherapy for the treatment of malignant tumors (Frei 1982). An early example of the use of neoadjuvant or preoperative chemotherapy was in the development of effective treatment for osteogenic sarcoma, the most common malignant bone tumor seen in the adolescent and young adult population (Rosen et al. 1982). The advantages of neoadjuvant chemotherapy on theoretical grounds would appear to be the early elimination of metastatic microfoci of disease that exist in the majority of patients harboring fully malignant (ostensibly only) primary malignant tumors. Early aggressive therapy theoretically would not only destroy metastatic microfoci of disease that exists systemically, but by the use of aggressive chemotherapy that can cause regression of the primary tumor, presumably the emergence of resistant tumor cells would be prevented.