Second and Subsequent Recurrences of Osteosarcoma: Presentation, Treatment, and Outcomes of 249 Consecutive Cooperative Osteosarcoma Study Group Patients

Abstract

To our knowledge, this is the first report of survival estimates derived from large cohorts of unselected patients with second and subsequent osteosarcoma recurrences. It confirms the overwhelming importance of surgical clearance. Prognostic indicators after rerecurrences resemble those known from first recurrence. The exact role of re-treatment with chemotherapy, particularly in the adjuvant situation, remains to be defined.

Surgical Resection of Relapse May Improve Postrelapse Survival of Patients With Localized Osteosarcoma

“…Current published data [3] suggest that postrelapse survival is possible only if the patient is rendered disease-free and attains a second complete remission. Although surgical resection of the relapse seems mandatory for attaining a second complete remission, the role of chemotherapy and other adjuvant modalities of therapy is less defined.…”

“…In the Cooperative Osteosarcoma Study Group (COSS) [2], 39% of patients who underwent successful surgical ablation of relapse disease were alive at 5 years, whereas none of the patients in whom surgical clearance of relapse was not performed remained alive. Survival was also possible in 32% to 58% of those patients who subsequently developed second and subsequent relapses provided surgical clearance was performed [3]. Other studies have suggested that complete surgical clearance of relapse may enable 30% to 39% of relapsed patients to survive 7 to 10 years [1,5].…”

Letter to the Editor: Surgical Resection of Relapse May Improve Postrelapse Survival of Patients with Localized Osteosarcoma

“…Third, the authors cited the studies by Bacci G et al [1], Bielack SS et al [2], and Chou AJ et al [3] in their Table 2 and Discussion section. The words ''recurrence'' or ''recurrent'' can be found in the titles of all three studies.…”

Reply to the Letter to the Editor: Surgical Resection of Relapse May Improve Postrelapse Survival of Patients with Localized Osteosarcoma

“…This term has been used to include reemergence of disease after successful primary treatment regardless of its location. In fact, studies by Bacci et al [1] and Bielack et al [2] challenge the assumption that patients with lung metastases may have a worse prognosis than patients with local recurrence or recurrence in bone. A major determinant of survival is the ability to render the patient free of disease following a second relapse.…”

“…This appears to be easier to achieve in bone than in the lung, and may lead one to believe that patients with bone relapse have a better prognosis. Aggressive treatment of the relapse, as in the Cooperative Osteosarcoma Study Group [2], has shown an impressive survival rate even in patients with multiple pulmonary relapses.…”