Perioperative chemotherapy in the treatment of osteosarcoma: a 26-year single institution review

Abstract

BackgroundChemotherapy in the multimodality treatment of osteosarcoma has improved survival. Reported outcomes on adult patients are limited. Poor necrosis rates post neoadjuvant chemotherapy (NAC) is considered an adverse prognostic factor and attempts have been made to improve survival in this group.Patients and methodsAdult and young adult patients diagnosed with osteosarcoma between January 1986 and August 2012 were retrospectively reviewed. Patients identified were stratified according to stage (localised or metastatic) and age (≤40 and >40 years). Event free survival (EFS) and overall survival (OS) outcomes were determined. In patients with localised disease ≤40 years, survival was assessed according to necrosis rates post NAC (<90 and ≥90%). NAC consisted of two cycles of methotrexate alternating with doxorubicin/cisplatin (MAP) followed by definitive surgery. Those with ≥90% tumour necrosis continued on MAP. Patients with <90% necrosis received ifosfamide and etoposide (IE) post operatively.ResultsA total of 108 patients were reviewed and 97 were included. Median age was 23 years (range 16–75) and 70% of patients were male. Five year EFS and OS across all groups was 57% and 63% respectively. Of the patients with localised disease (N = 81), 5-year overall survival (OS), with a median follow up of 7 years (2–26) was 70% (p < 0.0001). Patients aged 16–40 (N = 68) with localised osteosarcoma had a significantly improved 5-year OS (74%) compared to those >40 years (N = 13) (42%) (p = 0.004). Of the 68 patients with localised osteosarcoma ≤40 years, 62 were evaluated according to necrosis rates post MAP. In 33 patients who achieved ≥90% necrosis and continued MAP, 5-year OS was 82%. In 29 patients who had <90% tumour necrosis and received adjuvant IE, 5-year OS was 68% (p = 0.15). Multivariate analysis confirmed age and stage as prognostic factors but not poor necrosis rates in our treated population.ConclusionsLong-term survival outcomes in a predominantly adult Irish population are similar to large reported trials. Age and stage at diagnosis are prognostic. Postoperative ifosfamide/etoposide alone in patients with poor necrosis rates is a feasible regimen, but its role in the adjuvant setting remains uncertain.Electronic supplementary materialThe online version of this article (doi:10.1186/s13569-015-0032-0) contains supplementary material, which is available to authorized users.

Functional outcome of surgical treatment of adults with extremity osteosarcoma after megaprosthetic reconstruction—single-center experience

“…That results are similar to the results presented by other European centers [6][7][8][9]. Results presented by German-Austrian-Swiss group in 1709 patients were slightly worst (5-year OS rate 49%), but the group also included patients treated with amputations [10].…”

Long-term follow-up in adults with extremity osteosarcoma: comparison of different surgical procedures – single-center experience

“…In the work of the German group, in which the study group consisted of 1709 patients, OS was 48.9% and was slightly worse than the survival results obtained in our group [3][4][5][6].…”

“…Despite the increased risk of local recurrence, this is currently considered as the optimal treatment procedures. Published research shows that patients undergoing such treatment are characterized by a longer OS rate as compared with patients after amputation, not to mention physical disability and its psychological effects that occur in patients undergoing such a mutilating procedure [6,7].…”

Cisplatin selects for stem-like cells in osteosarcoma by activating Notch signaling

“…The introduction of adjuvant and neoadjuvant chemotherapies have greatly improved the long-term survival for osteosarcoma patients [3, 4], but chemo-resistance and recurrence remain common outcomes. Cisplatin is an effective antitumor agent with a wide spectrum of activity against solid tumors, and the inclusion of cisplatin in osteosarcoma treatment has improved outcome for patients with high grade disease [5].…”