Clinical Prognostic Factors and Outcome in Pediatric Osteosarcoma: Effect of Delay in Local Control and Degree of Necrosis in a Multidisciplinary Setting in Lebanon

Abstract

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 (15.8%) had metastatic disease to lungs, and three (7.9%) had synchronous multifocal bone disease with lung metastases. Adverse prognostic factors included nonlower extremity sites, metastasis, poor degree of necrosis, and delay of more than 4 weeks in local control. In bivariable analysis, only degree of necrosis was a prognostic predictor for survival and disease recurrence. CONCLUSION Treatment of pediatric osteosarcoma in a multidisciplinary cancer center in Lebanon resulted in survival similar to that in developed countries. Delay in local control was associated with worse outcome. The only statistically significant inferior outcome predictor was poor degree of necrosis at the time of local control.

Survival Analysis of 3 Different Age Groups and Prognostic Factors among 402 Patients with Skeletal High-Grade Osteosarcoma. Real World Data from a Single Tertiary Sarcoma Center

“…In addition, it is one of the few studies describing patient and treatment characteristics in three different age groups and therefore it could be directive to future studies. Other studies describe small study populations or present data from prospective or randomized controlled trials with different pre-empted endpoints and inclusion criteria [8,9,[14][15][16][17][18].…”

“…In contrast, some studies stated that no differences in survival were found between pediatric patients and older adults [11,12]. The variation in survival probabilities among age groups might be due to differences in tumor characteristics, chemotherapy regimens, pathohistological response, or different patient characteristics [9,[13][14][15][16][17][18].…”

Infectious Morbidity in Pediatric Patients Receiving Neoadjuvant Chemotherapy for Sarcoma

“…Longer duration of hospitalization reflects the burden of therapy-induced morbidity and accounts for important use of health care resources. There also was a significant association of MDIs with longer treatment delay, which in turn may contribute to worse event-free survival in the affected patients as has been demonstrated by others for osteosarcoma patients [ 45 , 46 ].…”

What is Elective Oncologic Surgery in the Time of COVID-19? A Literature Review of the Impact of Surgical Delays on Outcomes in Patients with Cancer

“…Conversely, in osteosarcoma, a study from Beirut reviewed 38 pediatric patients <18 years old from 2001–2012 with localized disease [ 50 ]. Patients were given neoadjuvant chemotherapy with the goal of getting patients to definitive local control with surgical resection at week 10.…”