Evaluation of follow-up investigations in osteosarcoma patients: Suggestions for an effective follow-up program

Körholz, Dieter; Verheyen, Jens; Kemperdick, H.F.; Göbel, U.

doi:10.1002/(sici)1096-911x(199801)30:1<52::aid-mpo13>3.0.co;2-a

Cited by 30 publications

(25 citation statements)

References 33 publications

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“…One of the main strengths of TOSS in determining the ultimate impact of surveillance is the use of overall survival as an end point rather than detection rate as has been the norm in other studies [5,12]. CT scanning of the chest is known to be more sensitive than chest radiography in detecting lung lesions, but its specificity in detecting metastatic lesions is lower.…”

Section: Discussionsupporting

confidence: 93%

“…Whooley et al [21] do not recommend CT scanning of the chest as a surveillance technique because of the high accuracy of chest radiography in detection of pulmonary metastases. Korholz et al [12] too demonstrated the efficacy of chest radiography in diagnosing metastasis in which 13 of 16 patients were detected by routine chest radiographs. The findings of Whooley and Korholz appear justified based on the results of our trial, which demonstrates the adequacy of chest radiography in detecting pulmonary metastasis with no deleterious impact on overall survival as also concluded by Cho.…”

Section: Discussioncontrasting

confidence: 57%

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Does Intensity of Surveillance Affect Survival After Surgery for Sarcomas? Results of a Randomized Noninferiority Trial

Puri

Gulia

Hawaldar

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Whether current postoperative surveillance regimes result in improved overall survival (OS) of patients with extremity sarcomas is unknown. Questions/purposes We hypothesized that a less intensive followup protocol would not be inferior to the conventional followup protocol in terms of OS. We (1) assessed OS of patients to determine if less intensive followup regimens led to worsened survival and asked (2) whether chest radiograph followup group was inferior to CT scan followup group in detecting pulmonary metastasis; and (3) whether less frequent (6-monthly) followup interval was inferior to more frequent (3-monthly) followup in detecting pulmonary metastasis and local recurrence.Methods A prospective randomized single-center noninferiority trial was conducted between January 2006 and June 2010. On the basis of 3-year survival of 60% with intensive, more frequent followup, 500 nonmetastatic patients were randomized to demonstrate noninferiority by a margin (delta) of 10% (hazard ratio [HR], 1.36). The primary end point was OS at 3 years. The secondary objective was to compare disease-free survival (DFS) (time to recurrence) at 3 years. At minimum followup of 30 months (median, 42 months; range, 30-81 months), 178 deaths were documented. Results Three-year OS and DFS for all patients was 67% and 52%, respectively. Three-year OS was 67% and 66% in chest radiography and CT groups, respectively (HR, 0.9; upper 90% confidence interval [CI], 1.13). DFS rate was 54% and 49% in chest radiography and CT groups, respectively (HR, 0.82; upper 90% CI, 0.97). Three-year OS was 64% and 69% in 6-monthly and 3-monthly groups, respectively (HR, 1.2; upper 90% CI,

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Section: Discussionsupporting

confidence: 93%

Section: Discussioncontrasting

confidence: 57%

Does Intensity of Surveillance Affect Survival After Surgery for Sarcomas? Results of a Randomized Noninferiority Trial

Puri

Gulia

Hawaldar

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…However, the potential benefits of early disease detection must be weighed against the missed work days, healthcare expenditures, and radiation exposure that increase with frequency of followup. Routine surveillance has been shown to improve survival in some malignancies [24] but not others [7,8,15,16], and its role in sarcoma has not been firmly established [5,13,19].…”

Section: Discussionmentioning

confidence: 99%

“…Given that these events are often detected on physical examination, performance of routine local imaging for the purpose of disease surveillance may not be beneficial, at least for most cases of extremity tumors. The limited data published on bone sarcomas suggest that local radiographs are not effective for surveillance [13,23]. Previous studies also suggest that routine MRIs are not beneficial for soft tissue sarcomas with 89% to 97% of local recurrences detected by patients [26,27].…”

Section: Discussionmentioning

confidence: 99%

“…Prior work suggests that, if detected early, such disease may be more easily treatable and, in some cases, even curable with complete metastasectomy [1,2]. Some studies conclude that more aggressive pulmonary screening may facilitate earlier detection of lung metastases and improve survival for soft tissue sarcoma, particularly for higher risk patients [5,6]; others, however, either failed to confirm this advantage or demonstrated that less frequent scans are more appropriate for lower risk patients [13,17,20]. Although the optimal imaging frequency and modality to maximize survival remain unknown, it is generally agreed that patients with sarcoma require some form of surveillance that should be designed to maximize the number of recurrences detected per examination performed; therefore, understanding the frequency and timing of these events is necessary to determine optimal followup schedules.…”

Section: Discussionmentioning

confidence: 99%

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Developing an Evidence-based Followup Schedule for Bone Sarcomas Based on Local Recurrence and Metastatic Progression

Cipriano

Griffin

Ferguson

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background The potential for local recurrence and pulmonary metastasis after treatment of primary bone sarcomas necessitates careful patient followup; however, minimal data exist regarding the incidence and timing of these events, and therefore an evidence-based surveillance protocol has not been developed. Questions/purposes The purposes of this study were to (1) describe the frequency and timing of local recurrence by histologic grade over time; (2) describe the frequency and timing of metastasis by histologic grade and diagnosis over time; and (3) use these data to either justify current surveillance schedules and/or propose modifications that may improve the rate of new pulmonary metastatic events detected per examination. Methods A retrospective review was performed of all patients who underwent resection of a primary, nonmetastatic bone sarcoma (excluding chordoma) at a single tertiary oncology center from 1989 to 2010. Of the 680 patients identified, 15 were excluded for loss of followup in the first 2 years, leaving 665 eligible for study. Of these, 437 patients were alive with no evidence of disease at the conclusion of the study (mean followup, 136 months; range, 25-321 months). Cox regression analysis was performed to evaluate and control for patient age, tumor size, tumor location, and surgical margins. With patients stratified by sarcoma grade, Kaplan-Meier survival curves were constructed for the endpoints of local recurrence and metastasis, and log-rank tests were used to compare the rates of these events between grades and diagnoses. The number of new pulmonary metastatic events per patientyear was calculated for each sarcoma grade over the time intervals used in current surveillance protocols (0-2, 2-5, 5-10, and [ 10 years) to facilitate development of a surveillance schedule that would maximize events detected per imaging study performed. In addition, to determine the effect of disease type, subset analysis was performed for osteosarcoma (OSA) and chondrosarcoma because these were the only diagnoses with sufficient numbers to support individual statistical analysis. Results With the numbers available for study, the overall local recurrence-free survival did not differ between sarcoma grades at any time points (p = 0.864). Metastasis-free survival curves differed between sarcoma grades (p \ 0.001), and the pattern of Grade 2 OSA metastasis was more consistent with other Grade 3 sarcomas, so it was

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A systematic review of evidence for and against routine surveillance imaging after completing treatment for childhood extracranial solid tumors

et al. 2020

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Background Regular off‐treatment imaging is often used to assess for recurrence of disease after childhood cancer treatment. It is unclear if this increases survival, or what burden surveillance places on patients, families, or health‐care services. This systematic review examines the impact of routine surveillance imaging after treatment of pediatric extracranial solid tumors. Methods Collaborative patient and public involvement informed the design and interpretation of this work. Thirteen electronic databases, conference proceedings, and trial registries were searched alongside reference list checking and forward citation searching from 1990 onwards. Studies were screened and data were extracted by two researchers. Risk of bias was assessed using a modified ROBINS‐I tool. Relevant outcomes were overall survival, psychological distress indicators, number of imaging tests, cost‐effectiveness, and qualitative data regarding experiences of surveillance programs. PROSPERO (CRD42018103764). Results Of 17 727 records identified, 55 studies of 10 207 patients were included. All studies used observational methods. Risk of bias for all except one study was moderate, serious, or critical. Data were too few to conduct meta‐analysis; however, narrative synthesis was performed. Surveillance strategies varied, and poorly reported, involving many scans and substantial radiation exposure (eg, neuroblastoma, median 133.5 mSv). For most diseases, surveillance imaging was not associated with increased overall survival, with the probable exception of Wilms tumor. No qualitative or psychological distress data were identified. Conclusions At present, there is insufficient evidence to evaluate the effects of routine surveillance imaging on survival in most pediatric extracranial solid tumors. More high‐quality data are required, preferably through randomized controlled trials with well‐conducted qualitative elements.

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Evaluation of follow-up investigations in osteosarcoma patients: Suggestions for an effective follow-up program

Cited by 30 publications

References 33 publications

Does Intensity of Surveillance Affect Survival After Surgery for Sarcomas? Results of a Randomized Noninferiority Trial

Does Intensity of Surveillance Affect Survival After Surgery for Sarcomas? Results of a Randomized Noninferiority Trial

Developing an Evidence-based Followup Schedule for Bone Sarcomas Based on Local Recurrence and Metastatic Progression

A systematic review of evidence for and against routine surveillance imaging after completing treatment for childhood extracranial solid tumors

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