Radical Surgery and Intensive Chemotherapy Are Necessaryfor Successful Treatment of Osteosarcoma
Authors:
J. Kruseová 1; H. Mottl 1; R. Kodet 2; J. Mraček 3; Z. Matějovský ml. 4; J. Schovanec 3; J. Šnajdauf 5; M. Rygl 5; I. Lišková 6; E. Kabíčková 1; J. Mališ 1; D. Sumerauer 1; E. Drahokoupilová 1; M. Ganevová 1; V. Šmelhaus 1; J. Starý 1
Authors‘ workplace:
Klinika dětské hematologie a onkologie 2. LF UK a FN Motol, Praha 2Ústav patologie 2. LF UK a FN Motol, Praha 3Ortopedická klinika 2. LF UK a FN Motol, Praha 4Ortopedická klinika 1. LF UK a IPVZ FN Bulovka, Praha 5Klinika dětské chirurgie 2. LF UK a FN Mo
1
Published in:
Klin Onkol 2009; 22(4): 168-175
Category:
Original Articles
Overview
Background:
We evaluated the therapeutic results in 44 patients (17 girls and 27 boys) with osteosarcoma from 1997 to 2006. Their average age was 12.8 years (2.5–20.2). 41 patients had localised disease and 3 had primary metastases.
Patients and Methods:
We treated our 44 patients using CCG 7921 POG 9351 INT 0133, the therapeutic protocol of the North American cooperative Children’s Oncology Group. The median of the follow up was 5.5 years (2–11 years).
Results:
40 patients went into complete remission. 19 patients suffered relapses. Of these, 17 patients died – 15 progressed, 1 died due to treatment related toxicity, 1 died due to secondary acute myeloid leukaemia. As a whole, the patients had a 5-year overall survival rate (OS) of 58.4% and a 5-year event free survival rate (EFS) of 46.7%. The patients with localised extremity osteosarcoma (n = 40) had a 5-year EFS rate of 51%. The patients with good histological response (n = 22) had a 5-year EFS rate of 63.6%, while patients with poor histological response (n = 18) achieved a 5-year EFS rate of 30.5% (p = 0.009).
Conclusion:
The results of treatment of patients with localised extremity osteosarcoma and patients with good histological response to preoperative treatment were very good. The prognosis of patients with axial localisation and metastatic involvement was poor.
Key words:
osteosarcoma – children – adolescents – disease detection – therapy
Sources
1. Meyers PA, Schwartz CL, Krailo M et al. Osteosarcoma: A Randomized, prospective trial of the addition of ifosfamide and/or murami tripeptide to cisplatin, doxorubicin, and high dose methotrexate. J Clin Oncol 2005; 23: 2004–2011.
2. Carrle D, Bielack SS. Current strategies of chemotherapy in osteosarcoma. Int Orthop 2006; 30(6): 445–451.
3. Bielack SS, Bielack KB, Delling G et al. Prognostic factors in high grade osteosarcoma of the extremities or trunk: An analysis of 1702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol 2002; 20: 776–790.
4. Longhi A, Errani C, De Paolis M et al. Primary bone osteosarcoma in the pediatric age: state of the art. Cancer Treat Rev 2006; 32(6): 423–436.
5. Picci P. Osteosarcoma (osteogenic sarcoma). Orphanet J Rare Diseases 2007; 2: 6.
6. Ferrari S, Palmerini E. Adjuvant and neoadjuvant combination chemotherapy for osteogenic sarcoma. Curr Opin Oncol 2007; 19(4): 341–346.
7. Harting MT, Blakely ML, Jaffel N et al. Long term survival after aggressive resection of pulmonary metastases among children and adolescents with osteosarcoma. J Pediatr Surg 2006; 41(1): 194–199.
8. Harting MT, Blakely ML. Management of osteosarcoma pulmonary metastases. Semin Pediatr Surg 2006; 15(1): 25–29.
9. Bacci G, Longhi A, Versari M et al. Prognostic factors for osteosarcoma of the extremity treated with neoadjuvant chemotherapy: 15 year experience in 789 patients treated at a single institution. Cancer 2006; 106(5): 1154–1161.
10. Jaffe N, Paerson P, Yasko AW et al. Single and multiple metachronous osteosarcoma tumors after therapy. Cancer 2003; 98(11): 2457–2466.
11. Longi A, Ferrari S, Bacci G et al. Long term follow up of patiens with doxorubicin induced cardiac toxicity after chemotherapy for osteosarcoma. Anticancer Drugs 2007; 18(6): 737–744.
12. Bacci G, Ferrari C, Longhi A et al. Second malignit neoplasm in patiens with osteosarcoma of the extremities treated with adjutant and neoadjuvant chemotherapy. J Pediatr Hematol Oncol 2006; 28(12): 774–780.
13. Bacci G, Longhi A, Versari M et al. Prognostic factors for osteosarcoma of the extremity treated with neoadjuvant chemotherapy: 15 year experience in 789 patients treated at a single institution. Cancer 2006; 106(5): 1154–1161.
14. Eselgrim M, Grunert H, Kuhne T et al. Dose intensity of chemotherapy for osteosarcoma and outcome in the Cooperative Osteosarcoma Study Group (COSS) trials. Pediatr Blood Cancer 2006; 47(1): 42–50.
15. Bacci G, Loro L, Longhi A et al. No correlation between methotrexate serum level and histologic response in the pre operative treatment of extremity osteosarcoma. Anti Cancer Drugs 2006; 17: 411–415.
16. Rodriguez GC, Shah N, McCarville MB et al. Outcome after local recurrence of osteosarcoma: the St. Jude Children’s Research Hospital experience (1970–2000). Cancer 2004; 100(9): 1928–1935.
17. Lewis IJ, Nooij MA, Whelan J et al. Improvement in histologic response but not survival in osteosarcoma patiens treated with intensified chemotherapy: a randomized phase III trial of the European Osteosarcoma Intergroup. J Natl Cancer Inst 2007; 99(2): 112–128.
18. Goorin AM, Swartzentruber DJ, Devidas M et al. Presurgical chemotherapy compared with immediate surgery and adjuvant chemotherapy for nonmetastatic osteosarcoma: Pediatric oncology group study POG- 865l. J Clin Oncol 2003; 8: 1574–1580.
19. Ferrari S, Palmerini E. Adjuvant and neoadjuvant combination chemotherapy for osteogenic sarcoma. Curr Opin Oncol 2007; 19(4): 341–346.
20. Salzer-Kuntschik M, Brand G, Delling G. Bestimmung des morphologischen Regressionsgrades nach Chemotherapie bei malignen konchentumoren. Pathologie 1983; 4: 135–141.
21. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481.
22. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 1966; 50: 163–170.
23. Harford CM, Wodowski KS, Rao BN et al. Osteosarcoma among children aged 5 years or younger. The St. Jude Children’s Research Hospital experience. J Pediatr Hematol Oncol 2006; 28(1): 43–47.
24. Bacci G, Longhi A, Beroni F et al. Primary high grade osteosarcoma: comparison between preadolescent and older patiens. J Pediatr Hematol Oncol 2005; 27(3): 129–134.
25. Smeland S, Muller C, Alvegard TA et al. Scandinavian Sarcoma Group Osteosarcoma Study SSG VIII: prognostic factors for outcome and the role of replacement salvage chemotherapy for poor histological responders. Eur J Cancer 2003; 39: 488–494.
26. Bacci G, Forni C, Longhi A et al. Local recurrence and local control of non metastatic osteosarcoma of the extremities: a 27year experience in a single institution. J Surg Oncol 2007; 96(2): 118–123.
27. Grimer RJ. Surgical options for children with osteosarcoma. Lancet Oncol 2005; 6(2): 85–92.
28. Swartz CL, Gorlick R, Teot L et al. Multiple drug resistence in osteogenic sarcoma: INT0133 from the Children’s oncology group. J Clin Oncol 2007; 25: 2057–2062.
29. Bacci G, Bertoni F, Longhi A et al. Neoadjuvant chemotherapy for high grade central osteosarcoma of the extremity. Cancer 2003; 97: 3068–3075.
30. Mialou V, Philip T, Kalifa Ch et al. Metastatic Osteosarcoma at Diagnosis-Prognostic factors and long term outcome-The French Pediatric Experience. Cancer 2005; 104: 1100–1109.
31. Kager L, Zoubek A, Potschger U et al. Primary metastatic osteosarcoma: presentation and outcome of patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol 2003; 21: 2011–2018.
32. Tiernan A, Mezer T, Michelagnoli M et al. A phase I/II study of doxorubicin, ifosfamide, etoposide and interval methotrexate in patients with poor prognosis osteosarcoma. Cancer 2006; 46: 345–350.
33. Sajadi KR, Heck RK, Neel MD et al. The incidence and prognosis of osteosarcoma skip metastases. Clin Orthop Relat Res 2004; 426: 92–96.
34. Crompton BD, Goldsby RE, Weinberg VK et al. Survival after recurrence of osteosarcoma: a 20 year experience at a single institution. Pediatric Blood Cancer 2006; 47(3): 255–259.
35. Nathan SS, Gorlick R, Bukata S et al. Treatment algorithm for locally recurrent osteosarcoma based on local disease free interval and the presence of lung metastasis. Cancer 2006; 107: 1607–1616.
36. Chou AJ, Merola PR, Wexler LH et al. Treatment of osteosarcoma at first recurrence after contemporary therapy: the memorial Sloan-Kettering Cancer Center experience. Cancer 2005; 104(10): 2214–2221.
37. Hawkins DS, Arndt CA. Pattern of disease recurrence and prognostic factors in patiens with osteosarcoma treated with contemporary chemotherapy. Cancer 2003; 98(11): 2447–2456.
38. Bielack BK, Bielack SS, Jurgens H et al. Osteosarcoma relace after combined modality therapy: An analysis of unselected patiens in the kooperative osteosarcoma study group (COSS). J Clin Oncol 2005; 23: 559–568.
39. Ferrari S, Briccoli A, Mercuri M et al. Postrelapse survival in osteosarcoma of the Extremities: Prognostic factors for long term survival. J Clin Oncol 2003; 21: 710–715.
40. Su WT, Chewning J, Abramson S et al. Surgical management and outcome of osteosarcoma patiens with unilateral pulmonary metastases. J Pediatr Surg 2004; 39(3): 418–423.
41. Bacci G, Longhi A, Cesari M et al. Influence of local recurrence on survival in patiens with extremity osteosarcoma treated with neoadjuvant chemotherapy: the experience of a single institution with 44 patients. Cancer 2006; 106(12): 2701–2716.
42. Berrak GS, Pearson M, Berberoglu S et al. High dose ifosfamide in relapsed pediaic osteosarcoma: therapeutic effects and renal toxicity. Pediatric Blood Cancer 2005; 44: 215–219.
43. Kruseová J, Sumerauer D, Stejskalová E et al. Diagnostické a léčebné postupy u nádorů ze skupiny Ewingův sarkom/periferní neuroepitheliální tumor (ES/PNET) u dětí a mladistvých. Klin Onkol 2006; 19(6): 293–299.
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Paediatric clinical oncology Surgery Clinical oncologyArticle was published in
Clinical Oncology
2009 Issue 4
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