EURAMOS-1: A trial of the European and American

Four international study groups undertook a large study in resectable osteosarcoma, which included two randomised controlled trials, to determine the effect on survival of changing post-operative chemotherapy based on histological response.

A randomised trial of the European and American Osteosarcoma Study Group to optimise treatment strategies for patients with resectable osteosarcoma based on histological response to pre-operative chemotherapy. Osteosarcoma is the most common bone cancer in children, adolescents, and youn adults, but is still a rare disease with an annual incidence of 2-3 million/year. The most common primary sites are the distal femur and proximal tibia, and 15-20% of patients have clinically detectable metastases at the time of diagnosis. The outcome for patients with osteosarcoma was poor before the use of effective chemotherapy, with 2-year overall survival in the region of 15-20%. The administration of multi-agent chemotherapy has dramatically improved the outcome. Most current series report 3-year disease-free survival rates of 60-70% following the administration of pre-operative multi-agent chemotherapy followed by surgical resection and continuation of chemotherapy post-operatively. These positive results, however, apply only to young patients with localised extremity tumours, while other patients - which make up at least one third of all affected individuals - have traditionally been excluded from prospective randomised trials. Judging from case series and cumulative analyses, their outcome is still considerably worse, with survival rates in the order of no more than 20-30% for patients with primary metastatic osteosarcomas or osteosarcomas of the axial skeleton.