Highly effective reduced toxicity dose-intensive pilot protocol for non-metastatic limb osteogenic sarcoma (SCOS 89)

Purpose Aggressive chemotherapy protocols for non-metastatic limb osteosarcoma have improved histological response without affecting prognosis. This study evaluated the toxicity and outcome of a dose-intensive, high-dose 3- to 5-drug pilot protocol, SCOS 89. Methods The cohort included 26 patients (14 male; ages 6.5–22 years) with non-metastatic limb osteosarcoma treated at a tertiary pediatric medical center between 1989 and 2013. Preoperatively, patients received two courses of once-weekly pulses of high-dose methotrexate (12–30 g/m 2 ) for 2 weeks; doxorubicin (90 mg/m 2 ) with dexrazoxane, combined with cisplatin (200 mg/m 2 ), was added in week 3. Following methotrexate, 760 mg/m 2 of folinic acid was administered. Postoperative chemotherapy was continued to a total of 14 courses of methotrexate, doxorubicin (up to a total dose of 360 mg/m 2 ), and cisplatin (up to a total dose of 560 mg/m 2 ). If toxicity occurred or