Scandinavian Sarcoma Group Osteosarcoma Study SSG VIII: prognostic factors for outcome and the role of replacement salvage chemotherapy for poor histological responders

Research output: Contribution to journalArticle


From 1990 to 1997, 113 eligible patients with classical osteosarcoma received neo-adjuvant chemotherapy consisting of high-dose methotrexate, cisplatin and doxorubicin. Good histological responders continued to receive the same therapy postoperatively, while poor responders received salvage therapy with an etoposide/ifosfamide combination. With a median follow-up of 83 months, the projected metastasis-free and overall survival rates at 5 years are 63 and 74%, respectively. Independent favourable prognostic factors for outcome were tumour volume < 190 ml, 24-h serum methotrexate > 4.5 muM and female gender. The etoposide/ifosfamide replacement combination did not improve outcome in the poor histological responders. In conclusion, this intensive multi-agent chemotherapy results in > 70% of patients with classical osteosarcoma surviving for 5 years. The data obtained from this non-randomised study do not support discontinuation and exchange of all drugs used preoperatively in histological poor responders. As observed in previous Scandinavian osteosarcoma studies, female gender appears to be a strong predictor of a favourable outcome. (C) 2003 Elsevier Science Ltd. All rights reserved.


  • S Smeland
  • C Muller
  • Thor Alvegård
  • T Wiklund
  • Thomas Wiebe
  • O Bjork
  • AE Stenwig
  • H Willen
  • T Holmstrom
  • G Folleras
  • O Brosjo
  • A Kivioja
  • Kjell Jonsson
  • O Monge
  • G Saeter
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology
  • Pediatrics
  • Radiology, Nuclear Medicine and Medical Imaging


  • prognosis, limb salvage, neo-adjuvant therapy, chemotherapy, osteosarcoma, clinical protocols, sex, Scandinavia
Original languageEnglish
Pages (from-to)488-494
JournalEuropean Journal of Cancer
Issue number4
Publication statusPublished - 2003
Publication categoryResearch