Adjuvant Methotrexate and Citrovorum-Factor Treatment of Osteogenic Sarcoma

Twenty consecutive patients with osteogenic sarcoma without visible metastases received adjuvant chemotherapy starting three weeks after local treatment of the primary tumor with operation or radiation. Adjuvant chemotherapy consisted of intravenous vincristine followed in 30 minutes by a six-hour infusion of methotrexate. Two hours later citrovorum factor was administered every six hours for 12 doses. Such treatment courses were given at three-week intervals. Ninety-eight patients referred to this center between 1950 and June, 1972, served as controls. The incidence of pulmonary metastases was significantly reduced by adjuvant chemotherapy to two as opposed to the expected 12.2 cases. Nineteen of the 20 patients treated with the adjuvant chemotherapy are surviving with follow-up periods of two to 23 months. Only six of 212 courses of treatment were associated with myelosuppression or stomatitis. These observations indicate that systemic (adjuvant) chemotherapy delays relapse and may provide definitive treatment in some patients with osteogenic sarcoma. (N Engl J Med 291:994–997, 1974)