title: Osteosarcoma: Current Treatment and a Collaborative Pathway to Success.
abstract: Osteosarcoma is the bone tumor that most commonly affects children, adolescents, and young adults. Before 1970, treatment primarily included surgical resection. However, the introduction of chemotherapy led to a dramatic improvement in prognosis for patients with localized osteosarcoma; long-term survival rates of less than 20% improved to 65% to 70% after the advent of multiagent chemotherapy regimens. Controversy concerning the ideal combination of chemotherapy agents ensued throughout the last quarter of the 20th century because of conflicting and often nonrandomized data. However, large cooperative group studies and international collaboration have demonstrated that the most effective regimens include the combination of high-dose methotrexate, doxorubicin, and cisplatin (MAP). The introduction of biologic agents such as muramyl tripeptide and the use of additional cytotoxic chemotherapy such as ifosfamide have not definitively improved the survival of patients with osteosarcoma. Collaborative efforts to increase understanding of the biology of osteosarcoma and the use of preclinical models to test novel agents will be critical to identify the path toward improving outcomes for patients. Once promising agents are identified, an international infrastructure exists for clinical trials. Herein, biologic, preclinical, and clinical trial efforts will be described along with future international collaborative strategies to improve outcomes for patients who develop this challenging tumor.
authors: Michael S. Isakoff, Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, CT; Stefan S. Bielack, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany; Paul Meltzer, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; and Richard Gorlick, The Children's Hospital of Montefiore; Bronx, NY.
authors: Michael S
authors: MS
authors: Isakoff
authors: Michael S. Isakoff, Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, CT; Stefan S. Bielack, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany; Paul Meltzer, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; and Richard Gorlick, The Children's Hospital of Montefiore; Bronx, NY.
authors: Stefan S
authors: SS
authors: Bielack
authors: Michael S. Isakoff, Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, CT; Stefan S. Bielack, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany; Paul Meltzer, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; and Richard Gorlick, The Children's Hospital of Montefiore; Bronx, NY.
authors: Paul
authors: P
authors: Meltzer
authors: Michael S. Isakoff, Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, CT; Stefan S. Bielack, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany; Paul Meltzer, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; and Richard Gorlick, The Children's Hospital of Montefiore; Bronx, NY. RGorlick@montefiore.org.
authors: Richard
authors: R
authors: Gorlick
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D001859:Bone Neoplasms / Q000175:diagnosis / Q000266:history / Q000401:mortality / Q000628:therapy*; D002648:Child; D003299:Cooperative Behavior; D004059:Diffusion of Innovation; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D033183:Interdisciplinary Communication; D007391:International Cooperation; D008495:Medical Oncology / Q000266:history / Q000639:trends; D012516:Osteosarcoma / Q000175:diagnosis / Q000266:history / Q000401:mortality / Q000628:therapy*; D010372:Pediatrics / Q000266:history / Q000639:trends; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult