Primary bone osteosarcoma in the pediatric age: State of the art (original) (raw)
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Biology and Therapeutic Advances for Pediatric Osteosarcoma
The Oncologist, 2004
Learning Objectives After completing this course, the reader will be able to: Discuss etiologic and biologic factors in osteosarcoma. Select the appropriate diagnostic work-up for patients with newly diagnosed osteosarcoma. Select appropriate multidisciplinary treatment for patients with newly diagnosed osteosarcoma. Discuss various surgical approaches to the management of newly diagnosed osteosarcoma. Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com Osteosarcoma is the most common malignant bone tumor in children and adolescents. Survival for these patients was poor with the use of surgery and/or radiotherapy. The introduction of multi-agent chemotherapy dramatically improved the outcome for these patients and the majority of modern series report 3-year disease-free survival of 60%–70%. This paper describes current strategies for treating patients with osteosarcoma as well as review of the clinical features, radiologic and...
Survival Trends and Long-Term Toxicity in Pediatric Patients with Osteosarcoma
Sarcoma, 2012
Background. This study was conducted to investigate the clinical characteristics and treatment results of osteosarcoma in pediatric patients during the past 30 years. Trends in survival rates and long-term toxicity were analyzed.Procedure. 130 pediatric patients under the age of 20 years with primary localized or metastatic high-grade osteosarcoma were analyzed regarding demographic, treatment-related variables, long-term toxicity, and survival data.Results. Comparison of the different time periods of treatment showed that the 5-year OS improved from 58.6% for children diagnosed during 1979–1983 to 78.6% for those diagnosed during 2003–2008 (P=0.13). Interestingly, the basic treatment agents including cisplatin, doxorubicin, and methotrexate remained the same. Treatment reduction due to acute toxicity was less frequent in patients treated in the last era (7.1% versus 24.1% in patients treated in 1979–1983;P=0.04). Furthermore, late cardiac effects and secondary malignancies can beco...
Pediatric Osteosarcoma: Connecting Present and Future Approaches to Diagnosis and Treatment
Biomedical Journal of Scientific & Technical Research, 2020
Pediatric osteosarcoma is a highly aggressive type of cancer, affecting children of all ages. Early diagnosis is key to ensure better outcomes, as pre-metastatic lesions are easier to manage. For this reason, novel screening techniques, such as miRNA biomarkers, have been developed to complement the standard radiological approach to diagnosis. Furthermore, the standard of care in chemotherapeutic treatment is constantly revised, and new drugs are designed to minimize the toxic effects of the treatment whilst maintaining, or even improving, its efficacy. Immunotherapy and radiotherapy are two more disciplines which have demonstrated great promise in their capacity to exert strong anti-tumor properties in a clinical setting. Immunotherapeutic drugs like Mifamurtide, and radiological treatments such as proton beam therapy are starting to form an essential part of the golden standard of care. Lastly, innovations in orthopedic oncology provide surgical techniques with the potential to improve surgical outcomes whilst preserving as much of the patient's healthy tissue as possible. This review appreciates that there is a great promise held in the future of osteosarcoma treatment, and highlights where attention should be paid in the future.
BMC Cancer, 2011
Background: Osteosarcoma is the most common primary bone malignancy in childhood and adolescence. However, it is very rare in children under 5 years of age. Although studies in young children are limited in number, they all underline the high rate of amputation in this population, with conflicting results being recently reported regarding their prognosis. Methods: To enhance knowledge on the clinical characteristics and prognosis of osteosarcoma in young children, we reviewed the medical records and histology of all children diagnosed with osteosarcoma before the age of five years and treated in SFCE (Société Française des Cancers et leucémies de l'Enfant) centers between 1980 and 2007. Results: Fifteen patients from 7 centers were studied. Long bones were involved in 14 cases. Metastases were present at diagnosis in 40% of cases. The histologic type was osteoblastic in 74% of cases. Two patients had a relevant history. One child developed a second malignancy 13 years after osteosarcoma diagnosis. Thirteen children received preoperative chemotherapy including high-dose methotrexate, but only 36% had a good histologic response. Chemotherapy was well tolerated, apart from a case of severe late convulsive encephalopathy in a one-year-old infant. Limb salvage surgery was performed in six cases, with frequent mechanical and infectious complications and variable functional outcomes. Complete remission was obtained in 12 children, six of whom relapsed. With a median follow-up of 5 years, six patients were alive in remission, seven died of their disease (45%), in a broad range of 2 months to 8 years after diagnosis, two were lost to follow-up. Conclusions: Osteosarcoma seems to be more aggressive in children under five years of age, and surgical management remains a challange.
Abstract: Osteosarcoma is an aggressive and malignant bone tumor most commonly appearing around the knee and shoulder in adolescents and young adults. The tumors can be generally divided into those arising inside the bone and those arising on the surface of the bone. The course of the disease and its prognosis can be different. Multidisciplinary approach in diagnosis and treatment is mandatory. Surgical resection with wide margins after neoadjuvant chemotherapy and adjuvant chemotherapy after surgery is a current standard of care. Applying modern chemotherapy regimen and performing limb-salvage surgery calls for responsible, trained and highly engaged medical staff. If the treatment and management principles of osteosarcoma are followed, limb-sparing with 60-80% survival rates can be achieved. Basic science is making continuous advance in molecular mechanisms and biologic pathways that may yield more specific agents, less-toxic drugs that will further improve overall long-term survi...
Journal of Global Oncology, 2019
PURPOSE Outcomes in pediatric osteosarcoma have dramatically improved over the past few decades, with overall survival rates of 70% and 30% for patients with localized and metastatic disease, respectively. PATIENTS AND METHODS We retrospectively reviewed clinical characteristics and outcomes of 38 patients treated between 2001 and 2012 at a single institution in Lebanon. All patients received a uniform three-drug chemotherapy regimen consisting of cisplatin, doxorubicin, and methotrexate. Ifosfamide and etoposide were added to the adjuvant treatment regimen in case of metastatic disease and/or poor degree of tumor necrosis (< 90%). RESULTS After a median follow-up of 61 months (range, 8 to 142 months), patients with localized disease had 5-year overall and event-free survival rates of approximately 81% and 68%, respectively, whereas for metastatic disease, they were approximately 42%. The most common primary site was the long bones around the knee (n = 34; 89.5%). Six patients (1...
Osteosarcoma: Current Treatment and a Collaborative Pathway to Success
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015
Osteosarcoma is the bone tumor that most commonly affects children, adolescents, and young adults. Before 1970, treatment primarily included surgical resection. However, the introduction of chemotherapy led to a dramatic improvement in prognosis for patients with localized osteosarcoma; long-term survival rates of less than 20% improved to 65% to 70% after the advent of multiagent chemotherapy regimens. Controversy concerning the ideal combination of chemotherapy agents ensued throughout the last quarter of the 20th century because of conflicting and often nonrandomized data. However, large cooperative group studies and international collaboration have demonstrated that the most effective regimens include the combination of high-dose methotrexate, doxorubicin, and cisplatin (MAP). The introduction of biologic agents such as muramyl tripeptide and the use of additional cytotoxic chemotherapy such as ifosfamide have not definitively improved the survival of patients with osteosarcoma....
Survival Analysis in Pediatric Osteosarcoma
Indonesian Journal of Cancer, 2019
Background: Osteosarcoma is the most common bone malignancy in childhood and adolescence. Despite significant advances in diagnostic and therapeutic modalities, osteosarcoma has generally poor prognosis. Several studies highlighted the prognostic significance of demographic and clinical parameters in the pediatric population. Controversy exists about which obvious factors of mortality in some institutions. Meanwhile, little is known about the overall survival (OS) of pediatric osteosarcoma in Dharmais Cancer Hospital. The aim of this study is to estimate the OS in pediatric osteosarcoma. Methods: This retrospective cohort study enrolled 41 children with osteosarcoma during the period of January 2010-September 2017. Patients were selected using inclusion and exclusion criteria. Overall survival (OS) and patient variables were plotted using Kaplan-Meier. Results: Our result showed that all patients admitted to our hospital in advanced stages (IIB and III). Their median OS was 23 months (12.3-33.7 months) with the survival probability was 29.4%. Conclusions: Median OS of pediatric osteosarcoma in our institution was 23 months and the survival probability was 29.4%. It can be used as evidence showing lack of cancer awareness and early detection in our country.
Predictors of Chemotherapy Induced Adverse Events in Pediatric Osteosarcoma Patients
Asian Pacific Journal of Cancer Prevention, 2022
23 (1), 93-100 rate of 33.7% (Wiangon et al, 2011). Typically, 10% to 20% of patients have metastases at the time of diagnosis (Gianferante et al., 2017; Misaghi et al., 2018). A high burden of disease increases morbidity and mortality, compromising survival ability of affected patients (Misaghi et al., 2018). A multimodal treatment combining surgery and chemotherapy has been reported to increase a 5-year survival rate from 20% to 60% in patients with osteosarcoma (Jain and Kapoor, 2016).