Outcome after local recurrence of osteosarcoma

Abstract

BACKGROUND Despite improvements in therapy for osteosarcoma, approximately 4–10% of patients experience a local recurrence and have a poor prognosis. METHODS The authors analyzed prognostic factors for survival in 26 patients with a local recurrence of osteosarcoma who were treated between 1970 and 2000. RESULTS The initial surgical procedure was amputation in 20 patients (76.9%) and limb salvage in 6 patients (23.1%). The median time from the diagnosis of osteosarcoma to local recurrence was 1.2 years (range, 1.2 months–6.1 years). Eleven patients (42.3%) developed an isolated local recurrence and 15 patients (57.7%) developed local and distant recurrence. The 5‐year estimate of postrecurrence survival (PRS) (± 1 standard error) for the 26 patients was 19.2% ± 7.7%. Recurrence ≥ 2 years from the time of diagnosis was found to predict a better outcome (5‐year PRS of 50.0% ± 20.4%) compared with earlier recurrence (10.0% ± 5.5%) (P = 0.037). Patients with negative margins after initial surgery were found to have improved survival (5‐year PRS of 33.3% ± 13.6%) compared with patients with positive margins (7.1% ± 4.9%) (P = 0.015). Patients who underwent complete surgical resection at the time of recurrence were found to have a better PRS (5‐year PRS of 41.7% ± 14.2%) compared with patients who did not undergo surgery (0% ± 0%) (P < 0.001). CONCLUSIONS The prognosis for patients after local recurrence of osteosarcoma is poor. Complete surgical resection at the time of recurrence is essential for survival. Positive margins at the time of initial surgical resection and early recurrence appear to be poor prognostic factors. Cancer 2004. © 2004 American Cancer Society.

Management of Local Recurrence of Pediatric Osteosarcoma Following Limb-Sparing Surgery

“…In an earlier report from our institution, use of neoadjuvant chemotherapy, negative margins at initial surgery and at resection of the recurrent tumor, and a time interval of ≥2 years between diagnosis and local recurrence predicted a longer PRS. 4 Similar findings were reported by the Cooperative Osteosarcoma Study Group in an analysis of 38 patients with solitary osseous recurrence: the use of second-line chemotherapy, complete resection of the recurrent tumor, and time interval of >1.5 years between diagnosis and local recurrence were significantly associated with post-recurrence overall survival. 13 Others have found that presence of systemic recurrence at or before local recurrence predicts post-recurrent survival.…”

“…4,6 The management of locally recurrent disease is not well defined, especially in patients who have undergone limb-sparing surgery. 7,8 The best approach to manage a local relapse near a prosthesis or allograft remains unknown, and it is unclear whether further limb salvage should be attempted with the potential risk of obtaining close or even unintentional positive resection margins.…”

A Phase II Study of Cisplatin, Ifosfamide and Epirubicin Combination Chemotherapy in Adults with Nonmetastatic and Extremity Osteosarcomas

“…Cisplatin, ifosfamide and epirubicin combination chemotherapy was highly emetogenic. A similar frequency of emesis and fatigue was observed in other series [10, 12, 13]. …”

“…Generally, early and late cardiac toxicity was not reported in the osteosarcoma literature [10,11,12]. Furthermore, cardiac toxicity was assessed only clinically in a majority of the previous reports [7, 8, 13]. It is important to note that osteosarcoma is a disease of the adolescence; therefore, cardiac toxicity might be underestimated in the studies.…”

“…It has been known that the dose-dense or increased dose intensity concept is associated with higher response rates in osteosarcoma [7,10,11,12,13, 16]. Histologic response to chemotherapy has been demonstrated to be a major prognostic indicator in osteosarcoma and is sometimes used as a surrogate marker of outcome [16,17,18,19].…”