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

Abstract

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).

Factors influencing survival after recurrence in osteosarcoma: A report from the Children's Oncology Group

“…9 Patients with localized tumors at diagnosis and subsequent local recurrence have overall SAR up to 30%. 26 However, patients with localized disease at diagnosis with non-lung, distant or combination relapses tend to have very poor survival after recurrence. 22 Data from the Rizzoli Institute has shown patients with pulmonary recurrence with two or fewer nodules are most likely to survive after relapse.…”

Developing an Evidence-based Followup Schedule for Bone Sarcomas Based on Local Recurrence and Metastatic Progression

“…Given that these events are often detected on physical examination, performance of routine local imaging for the purpose of disease surveillance may not be beneficial, at least for most cases of extremity tumors. The limited data published on bone sarcomas suggest that local radiographs are not effective for surveillance [13,23]. Previous studies also suggest that routine MRIs are not beneficial for soft tissue sarcomas with 89% to 97% of local recurrences detected by patients [26,27].…”

Team Approach: Osteosarcoma of the Distal Part of the Femur in Adolescents

“…Patients without detectable metastases treated with modern cytotoxic chemotherapy and surgical resection have an approximately 70% long-term survival compared to ≤20% for patients with metastatic disease at time of diagnosis or those who develop local disease progression or metastasis over time. 8,13,14 The clinical scenario presented in this review is an example of the standard workup, systemic treatment, surgical resection and follow-up. The specific surgical reconstruction performed is but one option amongst many.…”