Chemotherapy in primary osteogenic sarcoma in patients over the age of forty

Abstract

ObjectiveIn this study, we sought to review the clinical and histopathological features and the chemotherapy regimens in osteogenic sarcoma in patients over 40 years of age, and we aimed at identifying the possible prognostic factors in this particular group of patients.MethodsWe reviewed 287 patients with osteosarcoma treated between the year 1986 and 2010. Patients from this group who met the following criteria were considered eligible for our study; presence of primary OS, had typical histological and radiographic features of OS, no prior history of cancer or any treatment elsewhere and no prior history of preexisting bone abnormalities.ResultsThe Kaplan–Meier survival curve for the entire group, with a 95% confidence interval, at two and five years showed the survival rates as 76.2% and 72.8% respectively. The surgical margin was a significant factor affecting the survival. Presence of a pathological fracture also had a significant effect on the survival rate.ConclusionOsteogenic sarcoma remains a challenging disease to treat. Despite the expectation that elderly patients may not tolerate aggressive modern chemotherapy as the younger patients, we believe that patients with primary OS over the age of 40 should be treated aggressively with effective chemotherapy and complete surgical excision whenever possible.Level of evidenceLevel IV, therapeutic study

EURO-B.O.S.S.: A European study on chemotherapy in bone-sarcoma patients aged over 40: Outcome in primary high-grade osteosarcoma

“…In contrast, a recent paper poses doubts on the need to administer chemotherapy to these patients (12). Some retrospective studies including osteosarcoma patients over 40 treated with chemotherapy have reported data showing a probability of survival similar to those achieved in younger patients (8,11).…”

“…Some retrospective studies including osteosarcoma patients over 40 treated with chemotherapy have reported survival probabilities similar to those achieved in younger patients (8,11). A retrospective EMSOS study (10) observed an advantage in terms of prognosis for those patients who received chemotherapy above those who did not; however, it did not provide details of the chemotherapy protocols used.…”

“…Only a few study reports contain data on the use of chemotherapy in patients older than 40 years with high-grade osteosarcoma (8)(9)(10)(11)(12). The use of intensive chemotherapy regimens in this age group may be complicated by concomitant diseases and/or physiological changes occurring with aging, including decreased hematopoietic tissue activity as well as decreased renal function with its implications for delayed drug excretion and toxicity (13)(14)(15).…”

Predictors of the Survival of Primary and Secondary Older Osteosarcoma Patients

“…They found that tumor site, metastasis at diagnosis, surgery, and surgical margins were significantly associated with survival, whereas chemotherapy had no influence on survival. However, some studies reported that aggressive treatment with chemotherapy can offer a favorable outcome for older osteosarcoma patients 11-13. Although osteosarcoma is radioresistant, some studies have reported that radiotherapy is an effect adjuvant treatment for local control 14, 15.…”

The Real-Life Journey of Elderly Patients in Soft Tissue and Bone Sarcomas: A Retrospective Analysis from a Sarcoma Referral Center

“…The even lower incidence of BS results in a paucity of data, which mainly derives from retrospective case series on osteosarcoma patients, confirming a worst prognosis in the adult population [29][30][31][32]. The distinct negative clinical features reported were the longer time from symptoms onset to diagnosis, a more advanced stage ab initio, primary location (more truncal tumors) in addition to specific treatments that are less aggressive, beside exclusion from clinical trials.…”