Recurrences following primary osteosarcoma in adolescents and adults previously treated with chemotherapy

Duffaud, Florence; Digue, Laurence; Mercier, Catherine; Dalès, Jean-Philippe; Baciuchka-Palmaro, M.; Volot, Françoise; Thomas, Philippe; Favre, R.

doi:10.1016/s0959-8049(03)00435-0

Cited by 54 publications

(59 citation statements)

References 35 publications

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“…Guidelines for surgical treatment of locally recurrent osteosarcoma have not been well established. Some authors have emphasized the importance of achieving complete surgical resection, and clinicians have asked whether amputation should be the preferred treatment [10,23,28]. In our analysis, with the numbers we had, we found no difference in either postrecurrence survival or local recurrence-free survival between limb-sparing surgery and amputation.…”

Section: Discussionmentioning

confidence: 46%

“…Although the benefit of chemotherapy for primary disease is widely accepted [14,17,24,26], the effect of chemotherapy on recurrent disease is not so clear. Some have recommended aggressive surgery and multiagent chemotherapy after recurrence [10]. However, Chou et al [9] and Grimer et al [12] reported no statistical improvement of postrecurrence survival by administration of second-line chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have reported on the clinical outcomes and prognostic factors of patients with locally recurrent osteosarcoma [4,6,10,12,19,23,28,29]. However, there are relatively little data on long-term clinical outcome and the results of different treatments.…”

Section: Introductionmentioning

confidence: 99%

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What Are the Factors That Affect Survival and Relapse After Local Recurrence of Osteosarcoma?

Takeuchi

Lewis

Satcher

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Despite improvements in treatment of primary osteosarcoma, treatment of patients who have local recurrence is not well defined. Questions/purposes We asked: (1) What are the 5-and 10-year overall survival rates of patients with osteosarcoma who have a local recurrence? (2) What factors are associated with better survival after a local recurrence? (3) Does chemotherapy affect overall survival after local recurrence? (4) What are the rates of rerecurrence after amputation and with limb salvage?Methods We reviewed 45 patients with nonmetastatic conventional high-grade osteosarcoma who had local recurrence between 1985 and 2007, during which time 461 patients were treated for the same disease. Seven patients with known local recurrence were lost to followup and not included in our study. The median age of the patients was 18 years, and minimum followup was 2 months (median, 39 months; range, 2-350 months). The primary tumor was located in the extremity in 36 patients and the pelvis in nine. The median time from initial surgery for resection or amputation of the primary tumor to local recurrence was 18 months (range, 2-149 months). Ten recurrences developed in bone and 35 in soft tissue. In 21 of the latter cases, the soft tissue recurrence was undetectable on conventional radiographs. Prognostic factors for overall patient survival after recurrence were evaluated by Kaplan-Meier survival and Cox multivariate analyses. Results Overall postrecurrence patient survival was 30% at 5 years and 13% at 10 years. Cox multivariate analysis revealed that concurrent metastasis (relative risk = 4, p = 0.003) and recurrent tumor size 5 cm or larger (relative risk = 13, p \ 0.0001) were independent predictors of worse survival. With the numbers available, treatment with chemotherapy after local recurrence was not associated with better survival (p = 0.54). Nine patients had a second local recurrence, and the actuarial risk of rerecurrence was 34% at 5 years. There was no difference in the frequency of rerecurrence between patients treated by amputation and wide local excision (p = 0.23).

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

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What Are the Factors That Affect Survival and Relapse After Local Recurrence of Osteosarcoma?

Takeuchi

Lewis

Satcher

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Especially at the forearm, hand, lower leg, foot, popliteus, axilla, inguinale and buttock, it is not easy to reserve such structures by surgical tumor resection with a strict wide margin. If high-grade malignant sarcomas are dissected from such structures without any adjuvant therapy and tumor cells are histologically positive at the surgical margin, the tumor could recur quickly within 6 months in all patients, and generally, it is reported that local recurrence rate is 100% with intralesional margin and 60-80% with marginal margin [1,2,15]. There are some adjuvant therapies to prevent local recurrence for margin-positive tumor resection such as postoperative radiotherapy, hyperthermia, intra-operative treatment with alcohol, distilled water or anticancer agents, but the effect of those therapies remains controversial.…”

Section: Discussionmentioning

confidence: 99%

A new limb salvage surgery in cases of high‐grade soft tissue sarcoma using photodynamic surgery, followed by photo‐ and radiodynamic therapy with acridine orange

Nakamura

Kusuzaki

Matsubara

et al. 2008

Journal of Surgical Oncology

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“…3c, d). The patient refused to accept any additional intensive chemotherapy and was discharged on oral chemotherapy with single agent etoposide.One-third of patients with osteosarcoma will present with recurrent/metastatic disease during the course of their disease [2]. The lung is the most common site of metastases, with 77 % to 92 % of patients experiencing recurrence at this site and it is reported to be the only site of metastasis in nearly two thirds of the patients.…”

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confidence: 99%

Chest Wall Metastasis Resulting from a Primary Extremity Osteosarcoma- a Dramatic Clinical Presentation

Krishnamurthy

2013

Indian J Surg Oncol

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Sir, Osteosarcoma is the most common primary malignancy of the bone, with a peak incidence in the second decade and an additional peak in the elderly individuals (seventh and eighth decades) [1]. Improvements in multimodal treatment for osteosarcoma, especially in the use of neoadjuvant and adjuvant chemotherapy have increased the disease-free and the overall survivals. Meanwhile, the prolonged survival of patients has permitted the appearance of new, significant, extra pulmonary targets for metastasis.A 12-year-old boy presented to us with an expansible swelling over the left distal femur, a Jamshidi needle biopsy was suggestive of a high grade osteosarcoma. His initial metastatic work up (CT chest and bone scan) was normal. He received six cycles of ifosfamide, doxorubicin and cisplatin based chemotherapy (4 neoadjuvant and 2 cycles of adjuvant) and a limb salvage surgery with a custom based megaprosthesis. The histopathology of the resected tumor showed residual osteosarcoma with 90 % necrosis. Four months following completion of his adjuvant chemotherapy, he presented to us with a rapidly increasing left anterior chest wall swelling over 2 weeks duration (Fig. 1a). A CT chest revealed an irregular 4×2 cm mildly enhancing mass lesion eroding the left 4th rib, the underlying pulmonary parenchyma was however normal (Fig. 1b). His locoregional disease was clinically under control as was also confirmed by a bone scan. A trucut biopsy from the chest wall swelling was suggestive of metastasis from osteosarcoma (Fig. 2a, b). In view of the short disease free interval and a rapid progression of the chest wall swelling; he was planned for upfront chemotherapy using high dose methotrexate, with a plan to incorporate a surgical resection based on the response. The chest wall lesion unfortunately progressed while the patient was on the secondcycle of chemotherapy to a attain a size of 9.3×8.4×7.7 cm. It was found to infiltrate the pericardium and the thymus; in addition multiple bilateral pleural and sub pleural based nodules were seen in both the lung field, suggestive of lung metastasis as seen in the PET-CT (Fig. 3c, d). The patient refused to accept any additional intensive chemotherapy and was discharged on oral chemotherapy with single agent etoposide.One-third of patients with osteosarcoma will present with recurrent/metastatic disease during the course of their disease [2]. The lung is the most common site of metastases, with 77 % to 92 % of patients experiencing recurrence at this site and it is reported to be the only site of metastasis in nearly two thirds of the patients. The most common site of the extra pulmonary metastases is bone; the unusual sites of metastasis include the brain, abdominal viscera, lymph nodes, pleura, pericardium and oral cavity. Surgery is an essential component of therapy in the relapse setting; multiagent chemotherapy may contribute to the improvements in the survival outcomes. A more aggressive clinical behavior seems to be a feature in these patients in whom the prognosis is extrem...

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Recurrences following primary osteosarcoma in adolescents and adults previously treated with chemotherapy

Cited by 54 publications

References 35 publications

What Are the Factors That Affect Survival and Relapse After Local Recurrence of Osteosarcoma?

What Are the Factors That Affect Survival and Relapse After Local Recurrence of Osteosarcoma?

A new limb salvage surgery in cases of high‐grade soft tissue sarcoma using photodynamic surgery, followed by photo‐ and radiodynamic therapy with acridine orange

Chest Wall Metastasis Resulting from a Primary Extremity Osteosarcoma- a Dramatic Clinical Presentation

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