Treatment algorithm for locally recurrent osteosarcoma based on local disease-free interval and the presence of lung metastasis.

Authors:	Saminathan S Nathan, Richard Gorlick, Susan Bukata, Alex Chou, Carol D Morris, Patrick J Boland, Andrew G Huvos, Paul A Meyers, John H Healey
Language:	Eng.
Date:	2006-10-02
Journal:	Cancer (0008-543X)
Release:	Cancer. 2006 Oct;107(7):1607-16
Abstract:	BACKGROUND: Local recurrence in osteosarcoma is clinically distinct from metastasis, although associated with a similar reduction in survival. The prognostic factors in locally recurrent osteosarcoma were investigated and these factors were translated into a management strategy. METHODS: In all, 407 consecutive patients with skeletal osteosarcoma between 1977 and 2002 were analyzed. Twenty-three patients with resectable local recurrence were analyzed. Clinical and tumor-related factors were assessed for significance in relation to survival and a management strategy was formulated based on factors found to be independently significant for survival. RESULTS: Seventeen of the 23 patients underwent primary resections and initial treatment, yielding an overall local recurrence rate of 4.2% for resectable cancer. Median time to local recurrence was 13 months (95% confidence interval, 9-16 months). The 5-year and 10-year survival rates in the recurrent cases were 29% and 10%, respectively. All patients received chemotherapy both for their primary and recurrent disease. Increased risk of local recurrence (P < .0001) was strongly correlated with positive margins of resection. The rate of local recurrence was not related to chemotherapy-associated necrosis in the primary tumor. Nevertheless, neoadjuvant therapy halved the risk of local recurrence (odds ratio, 1.92; P = .3, power 10%). The strongest correlate with poor survival was local recurrence within the first year after primary resection (P = .001), followed by metastasis at the time of first local recurrence (P = .04) and failure to achieve clinical remission after disease recurrence (P = .04). Chemotherapy-associated necrosis and margins of resection of the primary tumor were not significant prognostic variables for survival. Survival differed significantly among patients defined by local disease-free interval and lung metastasis (P = .0001). They required an individualized approach as captured in the management algorithm. CONCLUSION: There is a residual risk of local recurrence in patients despite favorable chemotherapy-associated necrosis and negative margins of resection. A treatment strategy emphasizing clinical remission at all identifiable sites offers the highest likelihood of survival in this patient population.
Copyright:	Cancer Department of Orthopaedics, Faculty of Medicine, National University of Singapore, Singapore, USA.
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Terms:	Adolescent, Adult, Aged, Aged, 80 and over, Algorithms, Bone Neoplasms, Child, Female, Humans, Lung Neoplasms, Male, Middle Aged, Neoplasm Recurrence, Local, Osteosarcoma, Survival Analysis