Controversies and Challenges in the Management of Osteosarcoma—an Indian Perspective

Mittal, Abhenil; Pushpam, Deepam; Ganguly, Shuvadeep; Kumar, Venkatesan Sampath; Khan, Shah Alam; Bakhshi, Sameer

doi:10.1007/s13193-021-01486-3

Cited by 5 publications

(9 citation statements)

References 123 publications

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“…A similar delay in presentation has been seen in developed countries such as the Netherlands (median of four months with a range of 1-36 months) [13]. At the All India Institute of Medical Sciences (AIIMS), New Delhi, 42% of patients presented after four months of symptoms [8]. In this study, 29% of OGS cases presented after four months of symptoms.…”

Section: Discussionsupporting

confidence: 81%

“…In 60% of the cases, the OGS presented in the second decade, as in other studies from India [12]. As described in other Indian studies, the patients included in our study were predominantly male [8]. Most cases of OGS (79%) occurred around the knee.…”

Section: Discussionsupporting

confidence: 76%

“…Even though the development of metastasis depends more on the intrinsic biology of a tumor, a delay in the management of OGS leads to tumor progression and the development of metastasis, resulting in a substantial decrease in OS [7]. In developing countries, a delay is usually expected due to the poor socioeconomic status of the patients and the long waiting lists in government hospitals [8]. Therefore, any reduction in delay in the management of OGS will improve OS.…”

Section: Introductionmentioning

confidence: 99%

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An Audit of Delays in the Management of Non-Metastatic Osteosarcoma at a Tertiary Care Center in South India

Samuel¹,

Yadav²,

Mounisamy³

et al. 2022

Cureus

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Background and objectiveDelays in the management of osteosarcoma (OGS) lead to tumor progression and the development of metastasis, resulting in a decrease in overall survival (OS). The primary objective of this study was to determine whether delays occur in implementing the individual steps in the management of OGS in South India. MethodsIn this study, core biopsy reports between October 2019 and October 2021 were retrospectively examined for a diagnosis of OGS. The primary outcome variables in this study were time to MRI, time to biopsy, time to biopsy report, time to neoadjuvant chemotherapy (NACT), time to surgery, and time to adjuvant chemotherapy (ACT). Statistical analysis was performed by comparing the outcome variables with the hypothesized mean. ResultsThere were 38 patients with primary non-metastatic OGS. Of these, 92% received NACT, and 74% completed full treatment. The mean time to MRI was 11.3 ± 6.7 days, mean time to NACT was 15.3 ± 12.7 days, mean time to surgery was 31.1 ± 15.3 days, and mean time to ACT was 29.7 ± 10.1 days. Time to MRI was more than seven days in 68% of the cases, while time to NACT was more than seven days in 74%. Time to surgery was more than 21 days in 83% of the cases, and time to ACT was more than 21 days in 82% of the cases. ConclusionBased on our findings, there is a significant delay (p<0.05) in time to MRI, time to NACT, time to surgery, and time to ACT. The delay in time to surgery is more than the delay in time to MRI, time to NACT, and time to ACT. The delay is due to a variety of reasons, the most common being the long waiting period at the hospital.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

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An Audit of Delays in the Management of Non-Metastatic Osteosarcoma at a Tertiary Care Center in South India

Samuel¹,

Yadav²,

Mounisamy³

et al. 2022

Cureus

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“…Author details 1 Centre for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India. 2 Department of Medical Oncology, Dr. B.R. Ambedkar Institute-Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences, New Delhi, India.…”

Section: Abbreviationsmentioning

confidence: 99%

“…Neoadjuvant and adjuvant chemotherapy along with surgery have significantly improved the long-term disease-free survival rate of patients with osteosarcoma [1]. Five-year disease-free survival rate for localised osteosarcoma is reported as 60-70%, whereas it is less than 20% in patients presenting with distance metastasis [1], although the survival is relatively lower in resource challenged countries [2,3]. Measurement of necrosis by histopathological evaluation (HPE) of resected lesion is the current gold standard for neoadjuvant chemotherapy (NACT) response assessment and an important prognostic factor for survival in patients with localized osteosarcoma [4]; however, it is only possible after surgery on completion of NACT.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive intravoxel incoherent motion MRI in prediction of histopathological response to neoadjuvant chemotherapy and survival outcome in osteosarcoma at the time of diagnosis

et al. 2022

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Background Early prediction of response to neoadjuvant chemotherapy (NACT) is important to aid personalized treatment in osteosarcoma. Diffusion-weighted Intravoxel Incoherent Motion (IVIM) MRI was used to evaluate the predictive value for response to NACT and survival outcome in osteosarcoma. Methods Total fifty-five patients with biopsy-proven osteosarcoma were recruited prospectively, among them 35 patients were further analysed. Patients underwent 3 cycles of NACT (Cisplatin + Doxorubicin) followed by surgery and response adapted adjuvant chemotherapy. Treatment outcomes were histopathological response to NACT (good-response ≥ 50% necrosis and poor-response < 50% necrosis) and survival outcome (event-free survival (EFS) and overall survival (OS)). IVIM MRI was acquired at 1.5T at baseline (t0), after 1-cycle (t1) and after 3-cycles (t2) of NACT. Quantitative IVIM parameters (D, D*, f & D*.f) were estimated using advanced state-of-the-art spatial penalty based IVIM analysis method bi-exponential model with total-variation penalty function (BETV) at 3 time-points and histogram analysis was performed. Results Good-responders: Poor-responders ratio was 13 (37%):22 (63%). EFS and OS were 31% and 69% with 16.27 and 25.9 months of median duration respectively. For predicting poor-response to NACT, IVIM parameters showed AUC = 0.87, Sensitivity = 86%, Specificity = 77% at t0, and AUC = 0.96, Sensitivity = 86%, Specificity = 100% at t1. Multivariate Cox regression analysis showed smaller tumour volume (HR = 1.002, p = 0.001) higher ADC-25th-percentile (HR = 0.047, p = 0.005) & D-Mean (HR = 0.1, p = 0.023) and lower D*-Mean (HR = 1.052, p = 0.039) were independent predictors of longer EFS (log-rank p-values: 0.054, 0.0034, 0.0017, 0.0019 respectively) and non-metastatic disease (HR = 4.33, p < 10–3), smaller tumour-volume (HR = 1.001, p = 0.042), lower D*-Mean (HR = 1.045, p = 0.056) and higher D*.f-skewness (HR = 0.544, p = 0.048) were independent predictors of longer OS (log-rank p-values: < 10–3, 0.07, < 10–3, 0.019 respectively). Conclusion IVIM parameters obtained with a 1.5T scanner along with novel BETV method and their histogram analysis indicating tumour heterogeneity were informative in characterizing NACT response and survival outcome in osteosarcoma.

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Determinants and impact of diagnostic interval in bone sarcomas: A retrospective cohort study

Sasi

Ganguly

Biswas

et al. 2022

Pediatric Blood & Cancer

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Background: Diagnostic delays in cancers are frequent in developing countries due to poor health infrastructure. Existing literature from developed countries suggests that diagnostic interval in bone sarcomas is primarily dictated by tumour biology with no impact on survival. This study evaluates the social and biological determinants of the diagnostic interval in bone sarcomas in a resource-challenged setting and assesses its impact on treatment outcomes. Methods:A retrospective single-institutional study was conducted on patients with high-grade bone sarcomas recorded in the sarcoma clinic database between 2003 and 2018. Baseline clinical characteristics and treatment outcomes were recorded. Logistic regression was performed to assess the impact of baseline clinical and social characteristics (distance from treating centre and rural vs. urban residence) on the diagnostic interval. Further, the impact of diagnostic interval on histologic response to neoadjuvant chemotherapy, amputation requirement in extremity sarcomas and survival was evaluated.Results: A total of 1227 patients were included for analysis. The median diagnostic interval was 4 months (3-7 months). Age above 18 years, Ewing sarcoma (ES) diagnosis, absence of fever at presentation and tumour size above 7.5 cm were predictors of a longer diagnostic interval (>4 months). The length of the diagnostic interval did not impact amputation requirement or survival outcomes. However, the proportion of patients with good necrosis post-neoadjuvant chemotherapy was lower among patients with longer diagnostic intervals (25% vs. 34⋅16%; p-value = .04). Conclusion:Tumour characteristics rather than social factors determined the diagnostic interval. Diagnostic interval did not impact survival outcomes even in a resource-constrained setting.

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Controversies and Challenges in the Management of Osteosarcoma—an Indian Perspective

Cited by 5 publications

References 123 publications

An Audit of Delays in the Management of Non-Metastatic Osteosarcoma at a Tertiary Care Center in South India

An Audit of Delays in the Management of Non-Metastatic Osteosarcoma at a Tertiary Care Center in South India

Non-invasive intravoxel incoherent motion MRI in prediction of histopathological response to neoadjuvant chemotherapy and survival outcome in osteosarcoma at the time of diagnosis

Determinants and impact of diagnostic interval in bone sarcomas: A retrospective cohort study

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