OBJECTIVE To summarize the experiences in intraarterial neoadjuvant chemotherapy for extremity osteosarcoma. METHODS Between January 2002 and December 2007, 111 patients with stage IIB extremity osteosarcoma received preoperative intraarterial chemotherapy after placing chemotherapy pump subcutaneously, en bloc resection and postoperative adjuvant chemotherapy. There were 63 males and 48 females with an average age of 18 years old (range: 14 - 39). The time from symptom onset to hospitalization varied from several days to 6 months. The induction chemotherapy regimen included epirubicin [50 - 70 mg/m(2) by 4-hour intraarterial infusion/day for 3 days] and epirubicin plus adriamycin [100 - 120 mg/m(2) by 2-hour intraarterial infusion/day for 3 days] repetitively every 2 - 3 weeks. Among which 24 cases only received 2 cycles of induction chemotherapy was assigned into the nonstandard chemotherapy group and 87 cases receiving 3 - 6 cycles of induction chemotherapy the standard chemotherapy group. The number of preoperative chemotherapeutical cycles of standard chemotherapy group depended on the clinical and radiographic evaluation of chemotherapy efficacy. RESULTS The median follow-up time was 28 (8 - 48) months. The rate of extremity preservation surgery was 89.53% (77/86) in the standard chemotherapy group and 37.5% (9/24) in the nonstandard chemotherapy group. Kaplan-Meier survival analysis showed that the 3-year overall survival rate and disease-free survival rate of all 111 cases were 68.3% and 65.9% respectively. There were significant differences in overall survival rate (38.9%, 80.0%, P = 0.000), disease-free survival rate (30.1%, 79.5%, P = 0.000), distant metastatic rate (66.67%, 16.09%, P = 0.0000) and local recurrence rate (58.33%, 13.79%, P = 0.0000) between two groups. CONCLUSIONS Standard intraarterial neo-adjuvant chemotherapy is more effective than nonstandard intraarterial induction chemotherapy to treat stage IIB extremity osteosarcoma.