title: Osteogenic sarcoma with clinically detectable metastasis at initial presentation.
abstract: OBJECTIVE
  Chemotherapy and surgery have improved the length of survival for patients with osteogenic sarcoma (OS) who present without metastatic disease. We reviewed our experience with patients with OS who presented with clinically detectable metastasis to determine the prognostic factors and the effects of surgery on the primary tumor and on metastatic disease.
  
  
  METHODS
  From 1975 to 1984 we treated 62 patients who had previously untreated OS with metastasis detected at presentation. All of these patients received intensive chemotherapy that included high-dose methotrexate; doxorubicin; and bleomycin, cyclophosphamide, and dactinomycin (BCD). Selected patients also received cisplatin. The intent of surgery was resection of the primary tumor and metastatic disease.
  
  
  RESULTS
  Survival was extremely poor; only 11% of patients survived, with a median survival of 20 months. Survival was not affected by use of preoperative chemotherapy versus immediate surgery, and did not correlate with serum lactate dehydrogenase (LDH) level, alkaline phosphatase level, or the site of the primary tumor. Survival did correlate with age, location of metastatic disease, histologic response to preoperative chemotherapy, and completeness of surgical resection of all sites of tumor. Resection of all sites of tumor identified at initial presentation was necessary for survival.
  
  
  CONCLUSIONS
  OS that presents with metastatic disease has a very poor prognosis with therapy, although therapy has achieved good results for patients without metastasis detected at diagnosis. Aggressive surgical resection of tumor is necessary for survival. The use of novel therapies at initial presentation is justified with this group of patients.
authors.affiliation: Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
authors.forename: P A
authors.initials: PA
authors.lastname: Meyers
authors.forename: G
authors.initials: G
authors.lastname: Heller
authors.forename: J H
authors.initials: JH
authors.lastname: Healey
authors.forename: A
authors.initials: A
authors.lastname: Huvos
authors.forename: A
authors.initials: A
authors.lastname: Applewhite
authors.forename: M
authors.initials: M
authors.lastname: Sun
authors.forename: M
authors.initials: M
authors.lastname: LaQuaglia
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D012516:Osteosarcoma / Q000175:diagnosis* / Q000556:secondary* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome