Long-term results of the co-operative German-Austrian-Swiss osteosarcoma study group's protocol COSS-86 of intensive multidrug chemotherapy and surgery for osteosarcoma of the limbs

Ann Oncol. 1998 Aug;9(8):893-9. doi: 10.1023/a:1008391103132.


Background: In an effort to intensify osteosarcoma therapy, systemic ifosfamide was added pre- and postoperatively to an already aggressive three-drug regimen. In a subgroup of patients, loco-regional treatment intensification was attempted by using the intraarterial route to give cisplatin.

Patients and methods: Patients < or = 40 years at diagnosis of a localised, de novo high-grade central extremity osteosarcoma were eligible for inclusion into study COSS-86 if registered within three weeks from biopsy. Doxorubicin, high-dose methotrexate, and cisplatin were given to all patients. Patients who fulfilled one or more of three defined high-risk criteria received early systemic treatment intensification by adding ifosfamide as the fourth agent. Preoperatively, these high-risk patients received cisplatin either intraarterially or intravenously.

Results: 171 eligible patients were entered, of which 128 were stratified into the high-risk group. When all 171 were analysed by intention-to-treat, actuarial overall and event-free survival rates at ten years were 72% and 66%, respectively. No benefit of intraarterial cisplatin application was detected. Cumulative treatment toxicity was considerable.

Conclusions: In a multicenter setting, intensive treatment of osteosarcoma according to protocol COSS-86 led to long-term disease-free survival for two thirds of patients. We saw no benefit of using the intraarterial route to administer cisplatin.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Arm / pathology
  • Arm / surgery
  • Bone Neoplasms / drug therapy*
  • Bone Neoplasms / pathology
  • Bone Neoplasms / surgery
  • Child, Preschool
  • Cisplatin / administration & dosage
  • Doxorubicin / administration & dosage
  • Female
  • Humans
  • Ifosfamide / administration & dosage*
  • Infusions, Intra-Arterial
  • Infusions, Intravenous
  • Leg / pathology
  • Leg / surgery
  • Male
  • Methotrexate / administration & dosage
  • Neoadjuvant Therapy
  • Osteosarcoma / drug therapy*
  • Osteosarcoma / pathology
  • Osteosarcoma / surgery
  • Risk Factors
  • Survival Analysis
  • Treatment Outcome


  • Doxorubicin
  • Cisplatin
  • Ifosfamide
  • Methotrexate