Prognostic factors for osteosarcoma of the extremity treated with neoadjuvant chemotherapy

Abstract

BACKGROUNDThe evaluation variables influencing systemic and local recurrence and final outcome are extremely important in defining risk‐adapted treatments for patients with nonmetastatic osteosarcoma of the extremity.METHODSA homogeneous group of 789 patients treated at a single institution between March 1983 and March 1999 with different protocols of neoadjuvant chemotherapy, with a minimum followup of 5 years, were retrospectively evaluated in relation to gender, age, serum levels of alkaline phosphatase, tumor site and size of the pathologic fracture, type of surgery, protocol of chemotherapy, surgical margins, and histologic response to preoperative treatment.RESULTSThe 5‐year event‐free survival (EFS) and overall survival rates were 60.1% and 67.5%, respectively. Upon univariate analysis, EFS was significantly related to the age of patients, serum value of alkaline phosphatase, tumor volume, histologic subtype, type of surgery, surgical margins, histologic response to preoperative treatment, and chemotherapy protocol. Local recurrences (4.8%) were significantly correlated with surgical margins. The 5‐year postrecurrence EFS survival was 17% and was significantly lower for patients who had a local recurrence and metastases than for those with metastases only. Patients who had a recurrence only in the lung had a postrecurrence survival rate significantly better than others, correlated with the number of metastatic nodules and the length of the disease‐free interval.CONCLUSIONSUpon multivariate analysis, age ≤ 14 years, high serum levels of alkaline phosphatase, tumor volume > 200 mL, a two‐drug regimen chemotherapy, inadequate surgical margins, and poor histologic response to treatment maintained independent prognostic values on the outcome of nonmetastatic osteosarcoma of the extremities. These factors must be considered when deciding risk‐adapted treatments for osteosarcoma patients. Cancer 2006. © 2006 American Cancer Society.

Intraarterial Chemotherapy for Extremity Osteosarcoma and MFH in Adults

“…This suggests that although age may be of prognostic importance, long-term survival using this regimen is sustained in older adults, a population that may be more difficult to treat due to inability to tolerate chemotherapy and comorbidities. These results compare favorably to those reported in the literature (Table 2) [3,5,6,20,22,35].…”

“…Two patients had local recurrence at a rate of 3.7%. This compares favorably to historical controls [3,5,6,10,20,22,35] (Table 2).…”

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Abstract The neoadjuvant treatment of osteosarcoma using intravenous agents has resulted in survival rates of 55% to 77% [3,5,6,20,22,35]. We designed a neoadjuvant chemotherapy protocol using combined intraarterial and intravenous agents to treat high-grade osteosarcoma and malignant fibrous histiocytoma of bone in an attempt to improve survival.

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Development and external validation of nomograms predicting distant metastases and overall survival after neoadjuvant chemotherapy and surgery for patients with nonmetastatic osteosarcoma: A multi‐institutional study

“…However, in osteosarcoma, other prognostic factors, including patient age,14, 15, 16 tumor location,5, 16 pathologic fracture,17 and responses to preoperative chemotherapy, have been reported to correlate strongly with survival 5, 16, 18. Therefore, for the prediction of survival after treatment, it would be desirable to consider these factors, and a comprehensive and easy‐to‐use tool that incorporated all of them and could be used to assess individualized survival would be valuable for decision making.…”

Combined effects of a third-generation bisphosphonate, zoledronic acid with other anticancer agents against murine osteosarcoma

“…Recently, the prognosis of these patients has improved substantially owing to the development of various adjuvant chemotherapies. However, these chemotherapies are not fully effective and as a result, 20% of all osteosarcoma patients still die owing to tumour metastasis (Link, 1993;Unni, 1996;Bacci et al, 2006). As a consequence, various new osteosarcoma therapies have been investigated worldwide, with many clinical trials performed on novel agents.…”