Journal of Surgical Oncology 2001;78:162±170 Adjuvant Chemotherapy for Osteosarcoma May Not Increase Survival After Neoadjuvant Chemotherapy and Surgical Resection KEITH R. BEREND, MD, 1 * RICARDO PIETROBON, MD, 2 JOSEPH O. MOORE, MD, 3 LOUIS DIBERNARDO, MD, 4 JOHN M. HARRELSON, MD, 1 AND SEAN P. SCULLY, MD, PhD 1 1 Department of Surgery, Division of Orthopaedics, Duke University Medical Center, Durham, North Carolina 2 Department of Surgery, Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, North Carolina 3 Department of Medicine, Division of Medical Oncology and Transplantation, Duke University Medical Center, Durham, North Carolina 4 Department of Pathology, Division of Surgical Pathology, Duke University Medical Center, Durham, North Carolina Background and Objectives: Osteosarcoma is a primary malignancy of bone. Current therapy includes neoadjuvant chemotherapy, surgery, and postoperative (adjuvant) chemotherapy. Prolonged treatment with chemo- therapeutic agents may place patients at increased risk for complications including secondary malignancy. The authors have had promising results with neoadjuvant therapy and surgery alone in the treatment of osteo- sarcoma. This study retrospectively examines neoadjuvant therapy and surgery alone for the treatment of primary osteosarcoma of bone with no evidence of distant metastases. Methods: Fifty-four patients, with localized osteosarcoma of bone received neoadjuvant therapy followed by de®nitive surgical resection. Thirty-®ve patients received chemotherapy after surgery (adjuvant group) and nineteen patients were followed without postoperative chemotherapy (no adjuvant group). Results: Tumor necrosis was predictive of survival. Kaplan±Meier analysis revealed the use of postoperative chemotherapy was not a predictor of improved outcome. Four patients in the adjuvant therapy group died of secondary malignancy compared with none of the no adjuvant therapy group. Patient age, sex, race, and tumor location were not predictive of survival. Conclusions: The use of adjuvant chemotherapy in the treatment of localized osteosarcoma of bone did not increase survival after neoadjuvant therapy and de®nitive surgical therapy. Instead, there was an increased incidence of secondary malignancy after its use. J. Surg. Oncol. 2001;78:162±170. ß 2001 Wiley-Liss, Inc. KEY WORDS: osteosarcoma; chemotherapy; survival INTRODUCTION Osteosarcoma is a primary malignant tumor of bone that represents approximately 1% of all newly diagnosed cancers in the US each year [1]. Osteosarcomas occur in all ages and represent the most common bony malignancy in adolescents [2]. Before the 1970s, osteosarcoma was associated with a dismal outcome and 5-year mortality rates of 80±85%. With the routine use of chemotherapy *Correspondence to: Keith R. Berend, MD, Duke University Medical Center, Division of Orthopaedics, Box 3000, Durham, North Carolina 27710. Fax No.: 919-681-7859. E-mail: kberend@mindspring.com Accepted 7 August 2001 ß 2001 Wiley-Liss, Inc.