Pediatric osteosarcoma: therapeutic strategies, results, and prognostic factors derived from a 10-year experience.
 Ninety-eight pediatric patients were treated with three separate protocols (Treatment and investigation of Osteosarcoma [TIOS] I, II, and III) and 47 developed recurrent disease (metastases and/or local recurrence).
 Actuarial overall disease-free survival (hereafter designated survival) was 43%.
 Over 90% of the patients were treated initially with preoperative intraarterial cisplatin (CDP).
 Postoperative chemotherapeutic regimens comprised high-dose methotrexate with leucovorin rescue (MTX-CF), Adriamycin [( ADR] doxorubicin; Adria Laboratories, Columbus, OH), and cyclophosphamide.
 Primary definitive treatment comprised amputation or limb salvage (TIOS I and TIOS III).
 Patients treated with preoperative CDP and surgery (TIOS I and III) had a 62% survival.
 Patients in TIOS II refused surgical extirpation; they were treated exclusively with chemotherapy and had a 23% survival.
 Survival in patients treated with amputation was 55% and limb salvage 58%.
 Prognostic factors considered significant in relation to development of pulmonary metastases comprised tumor burden (P = .04) and the percentage of tumor necrosis induced by preoperative chemotherapy (P = .01).
 Histopathologic subtype was marginally significant: chondroblastic was more favorable as opposed to osteoblastic (P = .05).
 These findings are compared with results and prognostic factors published in the literature.
