Disparate histologic responses in simultaneously resected primary and metastatic osteosarcoma following intravenous neoadjuvant chemotherapy.

Abstract

Seven patients with newly diagnosed metastatic osteosarcoma underwent simultaneous resection of the primary tumor and metastases following intravenous (IV) neoadjuvant chemotherapy. Histologic response was assessed in all tumor specimens. Disparate responses were noted between primary tumor and metastases and, in some cases, between two or more metastatic tumor deposits. The diverse histologic response to neoadjuvant chemotherapy suggests tumor cell heterogeneity. Changing postoperative therapy on the basis of the histologic response induced in the primary tumor may not be appropriate.

Clinical, therapeutic and prognostic features of osteosarcoma of the jaws – Experience of 36 cases

“…Huvos et al found the fibroblastic to be most common (Huvos,1991). Some authors consider craniofacial chondroblastic osteosarcoma to have an especially unfavourable prognosis (Garcia-Foncillas et al, 1993;Nachman et al, 1987) whereas the present study is in accordance to the findings of others that could not see a correlation between histological type and prognosis (Garrington et al, 1967). Therapeutic options for craniofacial osteosarcoma are surgery, radio-and chemotherapy which are employed according to age of the patient, histological classification and localization of the tumour.…”

High grade osteosarcoma of the extremities with lung metastases at presentation: Treatment with neoadjuvant chemotherapy and simultaneous resection of primary and metastatic lesions

“…In contrast with these findings in neoadjuvant treatment of nonmetastatic osteosarcoma histologic response to chemotherapy of the primary tumor is generally well correlated with prognosis [1] that seems to indicate that the primary lesion and the microscopic disease have the same chemosensitivity. To verify the assumption that histologic response of the primary tumor reflects chemotherapy efficacy on microscopic disease, Nachman et al [19] evaluated the degree of tumor necrosis after resection of primary and metastatic lesions in patients treated with neoadjuvant chemotherapy. In the seven cases tested by the authors, response to primary and secondary lesions differed.…”

Combined Treatment of Metastatic Osteosarcoma of the Spine

“…The discrepancy between the late recurrence on the one hand and the poor histologic response of the primary tumour on the other hand might be explained by a different response of the primary tumour and the micrometastases to neoadjuvant chemotherapy, which has been described previously [25]. To achieve local control even in primary osteosarcomas of the axial skeleton is significantly less likely than in osteosarcomas of the limb.…”