gms | German Medical Science

27th German Cancer Congress Berlin 2006

German Cancer Society (Frankfurt/M.)

22. - 26.03.2006, Berlin

Multimodale Therapie: Nivellierung von Schwächen oder Potenzierung von Qualität chirurgischer Therapie?

Meeting Abstract

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  • corresponding author presenting/speaker Stefan Bielack - Olgahospital - Pädiatrisches Zentrum, Stuttgart, Deutschland

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocIS016

The electronic version of this article is the complete one and can be found online at:

Published: March 20, 2006

© 2006 Bielack.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Osteosarcoma, the most frequent primary malignant bone tumor, is a prime example for the successful combination of surgical and chemotherapeutic treatment: Surgery alone - without chemotherapy - will lead to cure in only about 10% of patients. Chemotherapy alone - without surgery - will almost neverlead to cure. In contrast, combination of the two, however insufficient they may be on their own, can achieve long term, disease free survival in approximately 60-70% of patients. Therefore, there is absolutely no doubt that multimodal therapy of osteosarcoma potentiates the efficacy of surgical treatment. This had led to the complete abandonment of "surgery only" approaches in classical osteosarcoma. The treatment of osteosarcoma within prospective, multicentric, interdisciplinary protocols has become the standard of care. The Cooperative Osteosarcoma Study Group (COSS) performs such studies in Germany, Austria and Switzerland. The COSS group also offers an interdisciplinary infrastructure which guides participating institutions through treatment and thereby ensures high quality of care. Currently, most international groups use neoadjuvant, pre-operative induction chemotherapy prior to surgery. Tumor response to preoperative chemotherapy has emerged as one of the most important prognostic factors for the development of metastases. The current international, European/American intergroup trial EURAMOS-1 (, strives to improve the prognosis of patients with poor tumor response. While only surgery with "wide" resection margins can guarantee local safety, multi-modal therapy can also assist in leveling weaknesses in surgical treatment. A good response to pre-operative chemotherapy (and, if necessary postoperative radiotherapy) can reduce the risk of local recurrence in cases where wide resection margins are not achieved. In summary, multi-modal therapy represents the standard of care in osteosarcoma. Surgery alone is obsolete.