Long-term outcome for patients with high-grade osteosarcoma has improved with the addition of systemic

chemotherapy, but subsequent progress has been less marked. Modern, multiagent, dose-intensive第三军医大学新桥医院骨科张瑗

chemotherapy in conjunction with surgery achieves a 5-year event-free survival of 60C70% in extremity

localized, non-metastatic disease. A major, as yet unsolved, problem is the poor prognosis for metastatic

relapse or recurrence, and for patients with axial disease. This article reviews the current state of the art

of systemic osteosarcoma therapy by focusing on the experiences of cooperative osteosarcoma groups.

Also, we shed light on questions and challenges posed by the aggressiveness of the tumor, and we consider

potential future directions that may be critical to progress in the prognosis of high-grade

osteosarcoma.