Multidisciplinary approach to osteosarcoma (original) (raw)
Related papers
Clinical features in osteosarcoma and prognostic implications
Jornal de Pediatria, 2004
Objective: To identify the clinical features in osteosarcoma and to investigate their influence on the prognosis of children and adolescents presenting this disease. Material and methods: The records of children and adolescents with osteosarcoma treated by the Bone Tumors Group of the state of Rio Grande do Sul, Brazil, between January 1992 and December 2001 were reviewed. Results: Fifty consecutive patients were included in this study. Mean age at diagnosis was 13 years (3-22); 68% of the patients were males. The primary site of disease was the femur in 50% of the patients, tibia in 30%, pelvis in 4%, humerus in 10%, fibula in 2% and other sites in 4%. Nineteen patients presented metastases at diagnosis (38%). All patients received chemotherapy and were treated with three different schemes. As for surgical treatment, 26 patients (52%) had an amputation and 17 (34%) received conservative surgery. Serum lactic dehydrogenase > 1,000 UI/ml (p = 0.0159, log rank), tumor necrosis < 90% and presence of metastases had a negative influence on prognosis. The overall 5-year survival was of 33.2±7.2% with mean follow-up of 36 months (6-126). Event-free survival was 29.7±7%. The 5-year event-free survival in non-metastatic patients was 45±10.7%, and zero in metastatic patients (follow-up of 78.4 and 18.7 months, respectively). Only two out of 19 metastatic patients are alive and free of disease at 18 and 30 months respectively. Conclusion: Metastatic disease at diagnosis, serum levels of serum lactic dehydrogenase > 1,000 UI/ml and tumor necrosis < 90% are predictors of unfavorable prognosis. The excessively high incidence of metastatic patients may suggest the presence of an aggressive pattern of disease in our population, or may indicate late diagnosis.
Real World Experience with Osteosarcoma from a Tertiary Cancer Centre in India
Background: Osteosarcoma represents the commonest category of bone tumors in the children and young adults and stability in its incidence rates have been observed throughout the world. The present study evaluated the varied profile of Indian patients with osteosarcoma with a special emphasis on the survival patterns in a tertiary cancer care centre in India. Methods: A retrospective review of all patients diagnosed with osteosarcoma during the year 2000 to 2020 was included in the study. Details of their demographic, treatment and survival profile were collected from the electronic medical records of the patients. Results: Among 112 patients, male gender (75.9%), disease in extremity sites (89.3%), conventional histology (95.5%), serum alphos >120U/L (75.9%) and non-metastatic disease at presentation (66.1%) and IAP regime (57.1%) were more commonly reported. The OS of the patients was 51% at 20 years. Statistical associations were observed with respect to age (p-value 0.019), site (p-value 0.017), grade (p-value 0.019), metastatic disease (p-value 0.006) and site of metastasis (p-value <0.0001). The PFS of the patients was 48% at 20 years and correlations were observed with respect to age (p-value 0.021), site (p-value 0.002), grade (p-value 0.016), metastatic disease (p-value 0.001), site of metastasis (p-value <0.0001) and HUVOS grade (p-value 0.026). Conclusion: With a static pattern in survival, there is an imperative need to characterize the genetic, epigenetic and immunologic basis of the disease in order to look for newer targets, inhibitors and therapies.
Annals of Oncology
To identify predictive factors of disease-free survival (DFS) in patients with non-metastatic osteosarcoma of the extremity, treated with primary chemotherapy and delayed surgery. The relationship between patient-related and treatment-related factors and prognosis was evaluated in 300 patients treated from 1986 to 1992 according to chemotherapy protocols based on high-dose methotrexate, cisplatin and doxorubicin, with the addition of ifosfamide in the post-operative phase. Univariate and multivariate analyses of prognostic factors for disease-free survival were performed. With a median follow-up of 9.2 (4.4-12) years, eight-year DFS was 59% (95% confidence interval (95% CI): 54-64.9). Univariate analyses showed that tumor volume > or = 150 ml (P = 0.002), histologic subtype (P = 0.028), age > 12 years (P = 0.044), high serum lactate dehydrogenase (P = 0.044) and alkaline phosphatase (P = 0.064) levels adversely affected DFS. Gender of patients and site of tumor did not influen...
Journal of Research in Orthopedic Science, 2022
Background and Objectives: Osteosarcoma (OS) is the most common cause of limb loss due to cancers. This study determines the mean survival time in patients with OS and prognostic factors. Methods: This retrospective study was conducted on patients with OS who were referred to Shah Vali Hospital, Yazd, Iran, from 2004 to 2018. The data on patient-related factors (age and sex), tumor-related factors (recurrence, recurrence site, and metastasis), and living status were obtained and analyzed. Results: Overall, 29 patients were included, of which 21(72.4%) were male. The mean age of patients was 21.3±8.4 (age range of 8-42) years. The tumor site was the lower limb in 23 patients (79.3%), the upper limbs in 4 patients (13.8%), and the axial in 2 patients (6.9%). Meanwhile, 13(44.8%) patients died due to OS, and one (6.9%) died for other reasons. The mean survival time in the subjects was 83.1±14.71 months. The 1-year survival of patients was nearly 90%, 3-year survival was about 64%, and 5-year survival was 40%. Also, 7(24.1%) patients had primary metastasis. The mean survival period was 22.25 months in patients with primary metastasis and 98.87 months in patients without primary metastasis (P=0.011). Among the patients, 15(51.7%) had a recurrence, of which 6(20.7%) were local, and 9(31%) were distant recurrences. The mean survival period after the recurrence of patients was 21.27±5.07 months. Conclusion: The mean survival period, according to sex, age, recurrence, and recurrence site, was not significant; however, it was significant according to metastasis.
TEN YEARS EXPERIENCE IN OSTEOSARCOMA; ANALYSIS AND TREATMENT RESULTS IN ALEXANDRIA; (2003- 2012)
Background: This study reviewed medical records of Osteosarcoma patients presented to Alexandria Clinical Oncology Department (ACOD) and Sporting Health Insurance Hospital between January 2003 and December 2012. Methods: A total of 87 patients were included in this study. Medical records were retrospectively reviewed and data were retrieved as regards epidemiologic aspects, clinicopathological details, staging, treatment modalities, treatment side effects and survival outcome. Results: Most of patients presented at the age 10-15 years. Females were slightly more affected than males. Most of patients presented at a localized disease stage (stage I, II) (75.85%). Most of the patients had recurrence during their follow up (77.01%) and commonest site was the lungs (77.11%). Median Overall survival (OS) was about 24 months and median Progression Free Survival (PFS) was about 12.17 months, while 3-years OS and PFS were about 35% and 21% respectively. Conclusion: Osteosarcoma survival correlates with primary bone site (axial or peripheral), pathology grade of tumor, stage, tumor size, tumor resection adequacy, response after induction chemotherapy, primary treatment modality. While no significant correlation was seen with age, gender, pathological subtype, and adding radiotherapy line.
Metastatic osteosarcoma at diagnosis
Cancer, 2005
BACKGROUND. The objective of this report was to estimate long-term outcome and prognostic factors in children and adolescents who presented with metastatic osteosarcoma at diagnosis. Patients were treated in six French pediatric oncology centers with surgery and multiagent chemotherapy, mainly with high-dose methotrexate. Their medical records were reviewed retrospectively.
Evaluation of Prognostic Factors in Patients with Osteosarcoma : The Husm Experience
2017
vii xii CHAPTER 1: INTRODUCTION 1.1 Problem Statement 2 1.2 Justification of The Study 3 1.3 Benefit of The Study 3 CHAPTER 2: LITERATURE REVIEW 2.1 Diagnosis 5 2.2 Incidence 7 2.3 Prognosis 8 2.4 Treatment 9 2.5 Prognostic Factors 2.5.1 Lactate Dehydrogenase (LDH) 13 17 2.5.2 Alkaline Phosphatase (ALP) 18 22 2.5.3 Age 23 2.5.4 Gender 24 2.5.5 Primary Site 25 2.5.6 Histological Type 26 2.5.7 Extent of The Disease 27 CHAPTER 3: OBJECTIVES 3.1 General Objective 29 3.2 Specific Objectives 29 3.3 Research Hypothesis 29 Evaluation of Prognostic Factors in Patients with Osteosarcoma: The HUSM Experience iv PAGE CHAPTER 4: METHODOLOGY 4.1 Study Design 31 4.2 Study Duration & Location 31 4.3 Study Population 31 4.4 Study Subjects 32 4.5 Sample Size Determination 33 4.6 Sampling Method 34 4.7 Data Collection 34 4.8 Variables 34 4.9 Definition of Operational Terms 35 4.10 Ethical Issues 35 4.11 Statistical Analysis 36 37 CHAPTER 5: RESULTS 39 58 CHAPTER 6: DISCUSSION 59 80 CHAPTER 7: CONCLUSI...
Response of Osteosarcoma to Chemotherapy
Clinical Positron Imaging, 2000
Objective: Positron emission tomography (PET) using fluorine-18-fluoro-2-D-deoxyglucose (FDG) is increasingly being used to evaluate and manage oncology patients. Several reports have documented its utility in diagnosis, staging, response to treatment, and tumor viability assessment. There is, however, a paucity of literature on PET scanning in patients with osteosarcoma. We report results of serial F-18 FDG-PET scans in 16 untreated patients with osteosarcoma who underwent chemotherapy prior to surgical resection of the primary tumor site. Procedure: Changes in tumor fluoro-2-D-deoxyglucose (FDG) uptake were correlated with percent tumor necrosis on histopathology. PET studies were analyzed by visual assessment of tumor uptake of FDG by 3 independent observers, calculating a tumor to normal background activity ratio (TBR) by drawing regions of interest (ROIs) around the tumor and background activity in the contralateral normal limb, and percent change in TBR values between baseline and presurgical study. Results: All patients had positive baseline scans. Baseline TBRs ranged between 2.5-8.7 and visual assessment of intensity of FDG uptake was 2-3 on a scale of 0-3. At histopathologic examination, 8 patients were classified as good responses with more than 90% tumor necrosis and 8 patients as poor responses with less than 90% necrosis. Tumor necrosis was accurately predicted on PET scan in 15/16 patients by visual assessment, 14/15 patients by final TBR value on presurgery scans, and 7/15 patients using percent change of TBR on serial scans.
Jokull
Background. Currently, 80-85% of the patients with osteosarcoma on the extremities can be safely treated with wide resection and limb preservation. Neo-adjuvant chemotherapy and a number of options for reconstruction after osteosarcoma resection (especially in chemotherapy-sensitive tumors) have increased long-term survival rates. The main goal of this study was to analyze longterm follow-up treatment results of pediatric and adolescent osteosarcoma patients in Macedonia. Methods. From the group of 22 patients with high-grade osteosarcoma, 4/22 patients were excluded, owing to lung metastases at first presentation or pelvic localization. Another 1/18 patient was excluded from the study due to indication for ablative surgery. Seventeen patients were planned for limbsparing surgery. The rest 17 patients received neo-adjuvant chemotherapy protocol according to the Scandinavian Sarcoma Group XIV. After neo-adjuvant chemotherapy a clinical and radiological response of the tumor has been observed. Results. Response to neo-adjuvant chemotherapy was good in 9/17 patients (52.4%). Early local recurrence appeared in 7/17 patients (41,2%). In 2 (2/7) of these patients recurrence was diagnosed in the second month after limb-salvage surgery. From seventeen patients with limb-sparing surgery, additional 4/17 ended with amputation due to local recurrence (23,5%). Lung metastases appeared in 11/17 patients or 64.7%. Mean survival time of the already deceased patients was 30,6 ± 18,4 months. Four (4/17) of the examinees (23,5%) survived longer than 5 years. Up to date 35.3% of the patients (6/17) are disease or event free with mean survival time of 55 months (range 27-108). Conclusion. There was significant different overall survival time, in our study, between the groups of patients with good response to neo-adjuvant chemotherapy compared to the group of patients with bad response (p=0.0047). Furthermore, overall survival time in our group of patients was shorter than the time Vol 65, No. 8;Aug 2015 36 Jokull Journal reported in the literature. We assume that the "fund of lost time" prior the diagnosis was the main reason for that.