Osteosarcoma of the spine: experience in 26 patients treated at the Massachusetts General Hospital

Schoenfeld, Andrew J.; Hornicek, Francis J.; Pedlow, Francis X.; Kobayashi, Wendy; Garcia, Ronald T.; DeLaney, Thomas F.; Springfield, Dempsey S.; Mankin, Henry J.; Schwab, Joseph H.

doi:10.1016/j.spinee.2010.05.017

Cited by 57 publications

(41 citation statements)

References 30 publications

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“…52,56 In one study in which patients were treated with high-dose methotrexate and Adriamycin, it was concluded that the preferred treatment for spinal osteosarcoma should include neoadjuvant therapy and at least a marginal resection to optimize outcome. 44 Similarly, a study of 26 patients treated with multimodality therapy, including en bloc resection and neoadjuvant therapy, demonstrated better survival than historical controls, 48 such as those that predate the modern chemotherapeutic era. 1,52 Others have reported that patients undergoing neoadjuvant chemotherapy with contaminated surgical margins have avoided local and distant recurrences and theorized that this may be due to chemotherapeutic response.…”

Section: Discussionmentioning

confidence: 99%

“…3 Thus, it is currently believed that multimodality therapy, including adjuvant or neoadjuvant chemotherapy and surgery, is the most effective treatment for primary osteosarcoma of the spine. 3,19,44,48,56 However, despite aggressive treatment, historically survival has been poor. 44,51,55 The primary goal of the surgical treatment of spinal sarcomas is curative resection with negative margins.…”

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confidence: 99%

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Osteosarcoma of the spine: prognostic variables for local recurrence and overall survival, a multicenter ambispective study

Dekutoski

Clarke²,

Rose

et al. 2016

SPI

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OBJECTIVE Primary spinal osteosarcomas are rare and aggressive neoplasms. Poor outcomes can occur, as obtaining marginal margins is technically demanding; further Enneking-appropriate en bloc resection can have significant morbidity. The goal of this study is to identify prognostic variables for local recurrence and mortality in surgically treated patients diagnosed with a primary osteosarcoma of the spine. METHODS A multicenter ambispective database of surgically treated patients with primary spine osteosarcomas was developed by AOSpine Knowledge Forum Tumor. Patient demographic, diagnosis, treatment, perioperative morbidity, local recurrence, and cross-sectional survival data were collected. Tumors were classified in 2 cohorts: Enneking appropriate (EA) and Enneking inappropriate (EI), as defined by pathology margin matching Enneking-recommended surgical margins. Prognostic variables were analyzed in reference to local recurrence and survival. RESULTS Between 1987 and 2012, 58 patients (32 female patients) underwent surgical treatment for primary spinal osteosarcoma. Patients were followed for a mean period of 3.5 ± 3.5 years (range 0.5 days to 14.3 years). The median survival for the entire cohort was 6.7 years postoperative. Twenty-four (41%) patients died, and 17 (30%) patients suffered a local recurrence, 10 (59%) of whom died. Twenty-nine (53%) patients underwent EA resection while 26 (47%) patients underwent EI resection with a postoperative median survival of 6.8 and 3.7 years, respectively (p = 0.048). EI patients had a higher rate of local recurrence than EA patients (p = 0.001). Patient age, previous surgery, biopsy type, tumor size, spine level, and chemotherapy timing did not significantly influence recurrence and survival. CONCLUSIONS Osteosarcoma of the spine presents a significant challenge, and most patients die in spite of aggressive surgery. There is a significant decrease in recurrence and an increase in survival with en bloc resection (EA) when compared with intralesional resection (EI). The effect of adjuvant and neoadjuvant chemotherapeutics, as well as method of biopsy, requires further exploration.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Osteosarcoma of the spine: prognostic variables for local recurrence and overall survival, a multicenter ambispective study

Dekutoski

Clarke²,

Rose

et al. 2016

SPI

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“…88 Ozaki et al 76 demonstrated a median survival of 23 months, with 3 of 22 patients surviving without disease for > 6 years after treatment; these authors found that patients with primary metastases, large tumors, and sacral tumors had lower overall survival.…”

Section: Osteosarcomamentioning

confidence: 98%

Primary osseous tumors of the pediatric spinal column: review of pathology and surgical decision making

Ravindra

Eli

Schmidt

et al. 2016

FOC

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“…2,[27][28][29] Occasionally, these tumours may arise in the pagetoid bone or in previously irradiated bones. 2,4 Imaging is usually complementary between CT and MRI as the osseous matrix is best seen on CT, while MRI can better define the extent of soft-tissue tumour involvement.…”

Section: Osteosarcomamentioning

confidence: 99%

“…Total resection may be difficult owing to the large size at presentation and may have poor prognosis with 30-40% 5-year survival, despite the use of neoadjuvant chemoradiation therapy. 25,28,30,31 Chondrosarcoma While mostly seen in the thoracic spine, sacral involvement is rarely seen. 25 Chondrosarcoma may arise from a pre-existing osteochondroma, most commonly in patients with multiple hereditary exostoses.…”

Section: Osteosarcomamentioning

confidence: 99%

Imaging of presacral masses—a multidisciplinary approach

Patel

Maturen

Kaza

et al. 2016

BJR

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Osteosarcoma of the spine: experience in 26 patients treated at the Massachusetts General Hospital

Cited by 57 publications

References 30 publications

Osteosarcoma of the spine: prognostic variables for local recurrence and overall survival, a multicenter ambispective study

Osteosarcoma of the spine: prognostic variables for local recurrence and overall survival, a multicenter ambispective study

Primary osseous tumors of the pediatric spinal column: review of pathology and surgical decision making

Imaging of presacral masses—a multidisciplinary approach

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