Osteosarcoma of the Head and Neck: Meta‐analysis of Nonrandomized Studies

Abstract

To assess the role of adjuvant therapy in the treatment of osteogenic sarcoma of the head and neck, treatment and survival information from 173 patients with osteosarcoma of the head and neck was entered into a database. A meta-analysis of the data was attempted with primary emphasis on the effect of adjuvant therapy on disease outcome. The overall 5-year survival was 37%. Patients with mandibular and maxillary tumors had similar survival rates; both groups fared significantly better than patients with extragnathic tumors (P<0.001). Treatment with surgery alone was associated with significantly longer survival rates (P<0.03) than surgery with adjuvant therapy. In the majority of patients reported, information about surgical margins was not available. For this reason, the differences may not adequately represent the effect of adjuvant therapy. While there have been encouraging results with adjuvant treatment protocols for long bone osteosarcoma, the ultimate role of radiation and chemotherapy in the management of osteosarcoma of the head and neck remains unproven. Nevertheless, we recommend that adjuvant therapy be considered due to the poor prognosis in osteosarcoma of the head and neck.

Impact of chemotherapy on the outcome of osteosarcoma of the head and neck in adults

“…These results are in line with our findings of an HR of 2.50 (95% CI = 1.09–5.71; p = .030) of chemotherapy on DFS in a univariate analysis, and no effect on OS. A meta‐analysis of 173 patients did not find a survival benefit for adjuvant chemotherapy; however, resection margins were not taken into account 11. The Surveillance, Epidemiology, and End Results database for 541 patients with osteosarcoma of the jaw did not provide data on chemotherapy 14…”

“…Because of the rarity of the disease, only small retrospective case series have been described 7, 9, 10. The single meta‐analysis (173 patients) and systematic review (201 patients) show conflicting results about the use of (neo‐)adjuvant chemotherapy 4, 11…”

Radiation‐induced osteosarcomas of the calvarium and skull base

“…This is considerably lower than the 5-year survival percentage reported for primary osteosarcomas of the head and neck, which range from 50% to 72%. 25,[30][31][32][33] This probably results from the finding that most radiation-induced osteosarcomas are of higher grade and may behave differently biologically.…”

Osteosarcoma of the cranial vault and skull base in pediatric patients

“…22,31,41,46 The most common craniofacial sites are the mandible and maxilla, followed by the calvaria and then the skull base. 3,5,35,38 Approximately half of all osteosarcomas occur in the context of Paget disease, fibrous dysplasia, or prior therapeutic irradiation, which may account for the rarity of pediatric cases. 7,33,42 Independent of radiation exposure, a history of retinoblastoma is also associated with an increased risk of craniofacial osteosarcoma.…”

“…7,33,42 Independent of radiation exposure, a history of retinoblastoma is also associated with an increased risk of craniofacial osteosarcoma. 38 Tumors arising secondary to a pathological process are typically more aggressive and have higher recurrence rates than those arising de novo. 54,59 Malignancy resulting from these predisposing factors is also more likely to appear at a more advanced age, 32 contributing to the low incidence of cranial osteosarcoma in the pediatric population.…”