Abstract: Objective To investigate the feasibility and efficacy of Pirarubicin (THP)-based doublet chemotherapy for refractory or recurrent high-grade osteosarcoma. Methods Between Jan.2007 and Dem.2010,30 patients with refractory or recurrent high-grade osteosarcoma were included in this analysis.Tumor response was usually evaluated every two chemotherapy cycles by CT/MRI scan.The primary end point was overall response rate,and secondary endpoint was progression-free survival (PFS),overall survival (OS) and disease control rate. Results All patients were given more than 2 cycles (range 2~7),a total of 90.Overall response rate was 10%.Median time to progression-free-survival and overall survival time were 2 (95%CI:2~12) and 12 months (95%CI:4~26) respectively.Main severe toxicities were grade 3 or 4 leukopenia(23.3%) and nausea and vomiting (11.1%). Conclusion THP-based doublet chemotherapy represents an active and well tolerated treatment for refractory or recurrent high-grade osteosarcoma patients.