Osteosarcoma of the spine

Ozaki, Toshifumi; Flege, Silke; Liljenqvist, Ulf; Hillmann, Axel; Delling, G.; Salzer-Kuntschik, M.; Jürgens, Heribert; Kotz, R.; Winkelmann, Winfried; Bielack, Stefan

doi:10.1002/cncr.10258

Cited by 234 publications

(62 citation statements)

References 33 publications

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“…This association stands to reason when considering that both these malignancies are classically known to be aggressive malignancies with significant soft tissue extension, particularly in the spine [23,27]. Notably, tumor size was found to be an independent survival determinant in patients with OGS, a finding that is consistent with prior cohort studies with smaller patient pools [17]. In contrast to OGS, however, tumor size in EWS showed no predictive ability for survival across both OS and DSS.…”

Section: Discussionsupporting

confidence: 78%

“…Small case series of treatment outcomes for patients with spinal OGS or EWS at individual institutions have been reported [12,16,17], but due partially to the infrequency of this malignancy in the axial skeleton, reports have been limited in terms of number of patients despite data spanning several decades. The Surveillance, Epidemiology, and End Results (SEER) registry began collecting cancer-related information in 1973 and today represents 30% of the US population, serving as a comprehensive source of population-level cancer data [18].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic determinants and treatment outcomes analysis of osteosarcoma and Ewing sarcoma of the spine

et al. 2017

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BACKGROUND CONTEXT Osteosarcoma (OGS) and Ewing sarcoma (EWS) are the two classic primary malignant bone tumors. Due to the rarity of these tumors, evidence on demographics, survival determinants, and treatment outcomes for primary disease of the spine are limited and derived from small case series. PURPOSE To use population-level data to determine the epidemiology and prognostic indicators in patients with OGS and EWS of the osseous spine. STUDY DESIGN/SETTING Large-scale retrospective study. PATIENT SAMPLE Patients diagnosed with OGS and EWS of the spine in the Surveillance, Epidemiology, and End Results (SEER) registry from 1973 to 2012. OUTCOME MEASURES Overall survival (OS) and disease-specific survival (DSS). METHODS Two separate queries of the SEER registry were performed to identify patients with OGS and EWS of the osseous spine from 1973–2012. Study variables included age, sex, race, year of diagnosis, tumor size, extent of disease (EOD), and treatment with surgery and/or radiation therapy. Primary outcome was defined as OS and DSS in months. Univariate survival analysis was performed using the Kaplan-Meier method and the log-rank test. Multivariate analysis was performed using Cox proportional hazards regression models. RESULTS The search identified 648 patients with primary OGS and 736 patients with primary EWS of the spine from 1973 to 2012. Mean age at diagnosis was 48.1 and 19.9 years for OGS and EWS, respectively, with OGS showing a bimodal distribution. The median OS and DSS were 1.3 and 1.7 years, respectively, for OGS, with OGS in Paget’s disease having worse OS (0.7 years) relative to the mean (log-rank p=.006). The median OS and DSS for EWS were 3.9 and 4.3 years, respectively. Multivariate cox regression analysis showed that age (OS p<.001, DSS p<.001), decade of diagnosis (OS p=.049), surgical resection (OS p<.001, DSS p<.001), and EOD (OS p<.001, DSS p<.001) were independent positive prognostic indicators for spinal OGS; radiation therapy predicted worse OS (hazard ratio [HR] 1.48, confidence interval [CI] 1.05–2.10, p=.027) and DSS (HR 1.74, CI 1.13–2.66, p=.012) for OGS. For EWS, age (OS p<.001, DSS p<.001), surgical resection (OS p=.030, DSS p=.046), tumor size (OS p<.001, DSS p<.001), and EOD (OS p<.001, DSS p<.001) were independent determinants of improved survival; radiation therapy trended toward improved survival but did not achieve statistical significance for both OS (HR 0.76, CI 0.54–1.07, p=.113) and DSS (0.76, CI 0.54, 1.08, p=.126). CONCLUSIONS Age, surgical resection, and EOD are key survival determinants for both OGS and EWS of the spine. Radiation therapy may be associated with worse outcomes in patients with OGS, and is of potential benefit in EWS. Overall prognosis has improved in patients with OGS of the spine over the last four decades.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Prognostic determinants and treatment outcomes analysis of osteosarcoma and Ewing sarcoma of the spine

et al. 2017

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“…However, radiotherapy is utilized in patients for whom complete resection is not feasible, such as in patients with tumors in the axial skeleton. In such cases, radiotherapy, in combination with standard chemotherapy, has been reported to result in higher overall survival then with chemotherapy alone [25, 26]. Newer radiation modalities are proving to be important for palliative management of pulmonary and osseous disease [24, 27, 28].…”

Section: Discussionmentioning

confidence: 99%

Targeted therapy of osteosarcoma with radiolabeled monoclonal antibody to an insulin-like growth factor-2 receptor (IGF2R)

Geller

Morris

Revskaya

et al. 2016

Nuclear Medicine and Biology

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Introduction Osteosarcoma overall survival has plateaued around 70%, without meaningful improvements in over 30 years. Outcomes for patients with overt metastatic disease at presentation or who relapse are dismal. In this study we investigated a novel osteosarcoma therapy utilizing radioimmunotherapy (RIT) targeted to IGF2R, which is widely expressed in OS. Methods Binding efficiency of the Rhenium-188(188Re)-labeled IGF2R-specific monoclonal antibody (mAb) to IGF2R on OS17 OS cells was assessed with Scatchard plot analysis. Biodistribution studies were performed in heterotopic murine osteosarcoma xenografts. Tumor growth was compared over a 24-day period post-treatment between mice randomized to receive 188Re-labeled IGF2R-specific murine mAb MEM-238 (188Re-MEM-238) or one of three controls—188Re-labeled isotype control mAb, unlabeled MEM-238,or no treatment. Results Results demonstrate the radioimmunoconjugate had a high binding constant to IGF2R. Both 188Re-MEM-238 and the isotype control had similar initial distribution in normal tissue. After 48 hours 188Re-MEM-238 exhibited a 1.8 fold selective uptake within tumor compared to the isotype control (p=0.057). Over 24 days, the tumor growth ratio was suppressed in animals treated with RIT compared to unlabeled and untreated controls (p=0.005) as demonstrated by a 38% reduction of IGF2R expressing osteosarcoma cells in the RIT group (p=0.002). Conclusions In conclusion, given the lack of new effective therapies in osteosarcoma, additional investigation into this target is warranted. Advances in Knowledge High expression of IGF2R on osteosarcoma tumors, paired with the specificity and in vivo anti-cancer activity of 188Re-labeled IGF2R-specific mAb suggests that IGF2R may represent a novel therapeutic target in the treatment of osteosarcoma. Implications for Patient Care This targeted approach offers the benefits of being independent of a specific pathway, a resistance mechanism, and/or an inherent biologic tumor trait and therefore is relevant to all OS tumors that express IGF2R.

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“…Treatment of osteosarcoma is described in various studies [4,8,11-14]. Surgical resection of the osteosarcoma is a critical part of the treatment regime, in addition to adjuvant chemotherapy and radiation.…”

Section: Discussionmentioning

confidence: 99%

Osteosarcoma of the spine: surgical treatment and outcomes

et al. 2013

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BackgroundThe goal of this study was to determine whether there are correlations between various options of surgical treatment and long-term outcome for spinal osteosarcoma.MethodsThis was a retrospective review of 16 patients with spinal osteosarcoma, who underwent surgical treatment from 1999 to 2010. Seven patients were given total en bloc spondylectomy (TES), while nine received piecemeal resection (there were seven cases of total piecemeal spondylectomy, one of sagittal resection, and one of vertebrectomy). The outcome and prognosis of the patients were evaluated, grouped by surgical treatment.ResultsAll 16 cases were followed for an average of 42.4 months. At follow-up, all patients noted that pain had eased or had gradually disappeared. Three months after surgery, eight patients (50.0%) had improved 1 to 2 grades in their neurological status, based on Frankel scoring. Six (37.5%) patients experienced local recurrence of the tumor, nine (56.3%) had metastases, and five (31.3%) died of the disease. Of the six patients who received a wide or marginal en bloc resection, none developed local recurrence or died from the disease. Conversely, of the ten patients who received intralesional or contaminated resections, six (60%) relapsed and five (50%) died from the disease.ConclusionsTES, with a wide margin, should be planned for patients with osteosarcoma of the cervical and thoracolumbar spine, whenever possible. When the patients are not candidates for en bloc resection, total piecemeal spondylectomy is an appropriate choice for osteosarcoma in the mobile spine.

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Osteosarcoma of the spine

Cited by 234 publications

References 33 publications

Prognostic determinants and treatment outcomes analysis of osteosarcoma and Ewing sarcoma of the spine

Prognostic determinants and treatment outcomes analysis of osteosarcoma and Ewing sarcoma of the spine

Targeted therapy of osteosarcoma with radiolabeled monoclonal antibody to an insulin-like growth factor-2 receptor (IGF2R)

Osteosarcoma of the spine: surgical treatment and outcomes

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