Amputation and Adriamycin in Primary Osteosarcoma

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Abstract
Adriamycin has been found effective in metastatic osteogenic sarcoma. To determine its efficacy in osteosarcoma without detectable metastases, 21 patients were given adjuvant adriamycin therapy two weeks (median) after surgical amputation of the primary lesion. Six courses of adriamycin (30 mg per square meter daily for three days, repeated every four to six weeks) were administered. Nineteen of the 21 patients survived from more than one to more than 32 months (median, more than nine months) after operation. Five of the 21 relapsed (two with local and three with pulmonary metastases). At 18 months, 71 per cent of treated patients may be expected to be free of pulmonary metastases as determined by life-table analyses (95 per cent confidence limits, 100 to 43 per cent), in contrast to 30 per cent of the series of 145 patients analyzed by Marcove et al. The data demonstrate an effect of adriamycin in delaying gross metastases from osteosarcoma and are consistent with chemotherapeutic eradication of micrometastases. (N Engl J Med 291:998–1000, 1974)