Die prognostische Bedeutung des Tumorvolumens beim Osteosarkom unter neoadjuvanter Chemotherapie

Abstract

In a retrospective analysis on 128 patients from the trials COSS-80, -82, -85 and -86 initial x-ray pictures were evaluated for tumor diameters in three planes and the prognostic meaning on survival was assessed. In a subset of patients (n = 27) the measured values were compared to values obtained by CT-Scan and a good correlation (r = 0.69) was found. Several parameters for tumor size were defined: absolute tumor length (ATL), relative tumor length (RTL, proportion of tumor to the length of the involved bone), absolute tumor volume (ATV, calculated by the ellipsoid formula) and relative tumor volume (RTL, tumor volume referred to the body surface area) and univariate and multivariate survival analysis were performed. Univariate analysis of metastasis free survival (MFS) revealed a high prognostic significance of the ATL, the ATV and the RTV. The RTL in this patient group demonstrated a tendency only toward an inferior prognosis in larger tumors. None of the patients with a ATV < 70 ml (n = 19) and only one of 33 patients with an ATV < 100 ml relapsed. Cox regression analysis was performed including the variables age, sex, site and response (> 90% tumor necrosis) in 84 patients. ATL and RTL do not enter the model, while the response proves its significance as a valid prognostic factor with a p-value of 0.0004. Adding the ATV as the measure of tumor size to the model it enters as the first term (p = 0.0000) followed by the response (p = 0.0002).(ABSTRACT TRUNCATED AT 250 WORDS)

Meta-analysis of limb salvage versus amputation for treating high-grade and localized osteosarcoma in patients with pathological fracture

“…It has been previously shown that factors other than the surgical choice of limb salvage or amputation can have an impact on patient outcome in these cases, including tumor size (24), poor response to chemotherapy (25), serum lactate dehydrogenase levels (26,27), anatomical location (9), unstable fracture without healing, age (28), histologic subtype (26), and the timing of the fracture. For high-grade and localized osteosarcoma, the occurrence of a pathological fracture is not regarded as an absolute contraindication to limb salvage.…”

Chemotherapy for Osteosarcoma without High-Dose Methotrexate: A 12-Year Follow-Up on 53 Patients

“…Paralysis, aphasia, and seizures usually resolved without sequels [14]. Since then, the use of HDMTX has been greeted with reactions ranging from enthusiasm to rejection [13,[15][16][17]. Rosen achieved response rates of 20-50% using HDMTX [13].…”

Primary Osteosarcoma of the Kidney

“…The tumor in our patient showed the typical behavior of very rapid recur rence: after local radiotherapy (50 Gy) within 4-5 weeks and sec ondly within 1 month after the first adjuvant chemotherapy using a protocol with relative low intensity. When polychemotherapy ac cording to the COSS protocol [23,24] (fig. 5), originally used for neoadjuvant treatment of primary skeletal osteosarcomas in young patients, was administered, the second relapse tumor grew to an unresectable mass within 8 weeks.…”

“…2) showed an extensive irregular delineated tumor in the left retroperitoneal space, partially calcified and infiltrating m. quadratus lumborum, m. psoas, stom ach, pancreas and the laterodorsal thoracoabdominal wall. Subse quently the patient received two cycles of polychemotherapy (modi fied COSS protocol [23,24], fig. 5).…”