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Abstract
The successful treatment of patients with osteosarcoma requires close cooperation
within an experienced multidisciplinary team including pediatric or medical oncologists,
surgeons, pathologists and radiologists. Therefore, therapy should be performed in
specialized centers able to provide access to the full spectrum of care. As in other
rare malignancies, treatment should be administered within prospective multicenter
trials. Therapy must include complete surgical removal of all detectable tumor sites
as well as multiagent chemotherapy. The chemotherapy regimen should include several
or all of the following four drugs: doxorubicin, high-dose methotrexate with leukovorin-rescue,
cisplatin and ifosfamide. Preoperative (neoadjuvant) plus postoperative (adjuvant)
polychemotherapy should be preferred, because it allows preparation for safe surgery
and preparation of the appropriate prosthesis for the individual patient. The choice
of the postponed definitive surgical procedure should be influenced by the anatomical
site of the primary tumor, its relationship to neighboring structures, such as vessels
and nerves, age and growth potential of the patient, and probably also by the response
of the tumor to preoperative chemotherapy. A major, as yet unsolved, problem is the
dismal prognosis for patients with unresectable or relapsed osteosarcomas. Novel approaches
are needed in order to improve their prognosis.