Information de reference pour ce titreAccession Number: | 01445386-200603010-00023.
|
Author: | Bacci, Gaetano M.D. 1,*,+; Longhi, Alessandra M.D. 1; Versari, Michela M.A. 1; Mercuri, Mario M.D. 2; Briccoli, Antonio M.D. 3; Picci, Piero M.D. 4
|
Institution: | (1)Department of Chemotherapy, Istituto Ortopedico Rizzoli, Bologna, Italy (2)Department of Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy (3)Department of Thoracic Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy (4)Oncologic Research, Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy (*)Address for reprints: Sezione di Chemioterapia, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
|
Title: | |
Source: | Cancer. 106(5):1154-1161, March 1, 2006.
|
Abstract: | BACKGROUND: The evaluation variables influencing systemic and local recurrence and final outcome are extremely important in defining risk-adapted treatments for patients with nonmetastatic osteosarcoma of the extremity.
METHODS: A homogeneous group of 789 patients treated at a single institution between March 1983 and March 1999 with different protocols of neoadjuvant chemotherapy, with a minimum followup of 5 years, were retrospectively evaluated in relation to gender, age, serum levels of alkaline phosphatase, tumor site and size of the pathologic fracture, type of surgery, protocol of chemotherapy, surgical margins, and histologic response to preoperative treatment.
RESULTS: The 5-year event-free survival (EFS) and overall survival rates were 60.1% and 67.5%, respectively. Upon univariate analysis, EFS was significantly related to the age of patients, serum value of alkaline phosphatase, tumor volume, histologic subtype, type of surgery, surgical margins, histologic response to preoperative treatment, and chemotherapy protocol. Local recurrences (4.8%) were significantly correlated with surgical margins. The 5-year postrecurrence EFS survival was 17% and was significantly lower for patients who had a local recurrence and metastases than for those with metastases only. Patients who had a recurrence only in the lung had a postrecurrence survival rate significantly better than others, correlated with the number of metastatic nodules and the length of the disease-free interval.
CONCLUSIONS: Upon multivariate analysis, age <= 14 years, high serum levels of alkaline phosphatase, tumor volume > 200 mL, a two-drug regimen chemotherapy, inadequate surgical margins, and poor histologic response to treatment maintained independent prognostic values on the outcome of nonmetastatic osteosarcoma of the extremities. These factors must be considered when deciding risk-adapted treatments for osteosarcoma patients. Cancer 2006. (C) 2006 American Cancer Society.
Copyright (C) 2006 John Wiley & Sons, Inc.
|
Author Keywords: | osteosarcoma; treatment; prognostic factors; limb salvage.
|
References: | 1. Delepine N, Delepine G, Desbois JC Monocentric therapy study: an approach to optimize the results of the treatment of osteosarcoma by protocol based upon HDMTX, associated with systematic conservative surgery. In: Humphrey GB, editor. Osteosarcoma in adolescent and young adults. Boston: Kluwer Academic, 1993: 124-132.
2. Kalifa C, Razafindrakoto H, Vassal G et al. Chemotherapy in osteogenic sarcoma: the experience of the pediatric department of the Goustave Roussy Institute. Cancer Treat Res. 1993; 62: 347-349.
3. Meyers PA, Heller G, Healey J et al. Chemotherapy for nonmetastatic osteogenic sarcoma: the memorial Sloan Kettering experience. J Clin Oncol. 1992; 10: 5-15.
4. Winkler K, Beron G, Kotz R et al. Neoadjuvant chemotherapy for osteogenic sarcoma: results of a cooperative German/Austrian study. J Clin Oncol. 1984; 6: 617-624.
5. Winkler K, Beron G, Delling G et al. Neoadjuvant chemotherapy for osteogenic sarcoma: results of a randomized cooperative trial (COSS-82) with salvage chemotherapy based on histological tumor response. J Clin Oncol. 1988; 6: 329-337.
6. Fuchs N, Bielack SS, Epler D et al. Long-term results of the cooperative German-Austrian-Swiss osteosarcoma study group's protocol COSS-86 of intensive multidrug chemotherapy and surgery for osteosarcoma of the limbs. Ann Oncol. 1998; 21: 890-899.
7. Goorin AM, Perez-Atayde A, Gebhardt M et al. Weekly high-dose methotrexate and doxorubicin for osteosarcoma; the Dana Farber Cancer Institute/the Children's Hospital-study III. J Clin Oncol. 1987; 5: 1178-1184.
8. Provisor AJ, Ettinger LJ, Nachman JB et al. Tretament of nonmetastatic osteosarcoma of the extremity with preoperative and postoperative chemotherapy: a report from the Children's Cancer Group. J Clin Oncol. 1997; 15: 76-84.
9. Bacci G, Picci P, Ferrari S et al. Primary chemotherapy and delayed surgery for nonmetastatic osteosarcoma of the extremities. Results in 164 patients preoperatively treated with high doses of methotrexate followed by cisplatin and doxorubicin. Cancer. 1993; 72: 3227-3238.
10. Ferrari S, Mercuri M, Picci P et al. Nonmetastatic osteosarcoma of the extremity: results of a neoadjuvant chemotherapy protocol (IOR/OS-3) with high-dose methotrexate, intraarterial or intravenous cisplatin, doxorubicin, and salvage chemotherapy based on histologic response. Tumori. 1999; 85: 458-464.
11. Bacci G, Briccoli A, Ferrari S et al. Neoadjuvant chemotherapy for osteosarcoma of the extremity: long-term results of the Rizzoli's 4th protocol. Eur J Cancer. 2001; 37: 2030-2039.
12. Bacci G, Ferrari S, Longhi A et al. High-dose ifosfamide in combination with high-dose methotrexate, doxorubicin and cisplatin in the neoadjuvant treatment of extremity osteosarcoma: preliminary results of an Italian Sarcoma Group/Scandinavian Sarcoma Group pilot study. J Chemother. 2002; 14: 198-206.
13. Fletcher CDM, Unni KK, Mertens F World Health Organization classification of tumors. Pathology and genetics of tumors of soft tissue and bone. Lyon: IARC Press, 2002: 341-367.
14. Gobel V, Jurgens H, Estpuler G et al. Prognostic significance of tumor volume in localized Ewing's sarcoma of bone in children and adolescent. J Cancer Res Clin Oncol. 1987; 113: 187-191.
15. Enneking WF, A system for the evaluation of the surgical management of musculoskeletal tumors. In: Enneking WF, editor. Limb salvage in musculoskeletal oncology. New York: Churchill Livingstone, 1987: 145-150.
16. Picci P, Bacci G, Campanacci M et al. Histologic evaluation of necrosis in osteosarcoma induced by chemotherapy. Cancer. 1985; 56: 1515-1521.
17. Bacci G, Picci P, Ruggieri P et al. Primary chemotherapy and delayed surgery (neoadjuvant chemotherapy) for osteosarcoma of the extremities. Cancer. 1990; 62: 2539-2553.
18. Souhami RL, Craft AW, Van der Eijken JW et al. Randomised trial of two regimens of chemotherapy in operable osteosarcoma. A study of the European Osteosarcoma Intergroup. Lancet. 1997; 350: 911-917.
19. Krailo M, Ertel I, Makley J A randomised study comparing high-dose methotrexate with moderate-dose methotrexate as components of adjuvant chemotherapy in childhood nonmetastatic osteosarcoma: a report from the Children Cancer Study Group. Med Pediatr Oncol. 1987; 15: 69-77.
20. Jaffe N, Smith E, Abelson HT, Frei E Osteogenic sarcoma: alterations in the pattern of pulmonary metastases with adjuvant chemotherapy. J Clin Oncol. 1983; 1: 251-254.
21. Goorin AM, Shuster JJ, Baker A, Horowitz ME, Meyer WH, Link MP Changing pattern of pulmonary metastases with adjuvant chemotherapy in patients with osteosarcoma: results from the multiinstitutional osteosarcoma study. J Clin Oncol. 1991; 9: 600-605.
22. Carsi B, Rock MG Primary osteosarcoma in adults older than 40 years. Clin Orthop. 2002; 397: 53-61.
23. Saeter G, Alvegard TA, Elomaa I, Stenwig AE, Holmstrom T, Solheim OP Treatment of osteosarcoma of the extremities with the T-10 protocol, with emphasis on the effects of preoperative chemotherapy with single agent high-dose methotrexate: a Scandinavian Sarcoma Group study. J Clin Oncol. 1991; 9: 1766-1775.
24. Bacci G, Ferrari S, Longhi A et al. Pattern of relapse in patients with osteosarcoma of the extremities treated with neoadjuvant chemotherapy. Eur J Cancer. 2001; 37: 32-38.
25. Smeland S, Muller C, Alvegard TA et al. Scandinavian Sarcoma Group Osteosarcoma Study SSG-VIII: prognostic factors for outcome and role of replacement salvage chemotherapy for poor histological responders. Eur J Cancer. 2003; 39: 488-494.
26. Spanier SS, Shuster JJ, Vander Griend RA The effect of local extent of the tumor on prognosis in osteosarcoma. J Bone Joint Surg Am. 1990; 72: 643-654.
27. Bramwell VHC, Burgers M, Sneath R et al. A comparison of two short intensive adjuvant chemotherapy regimens in operable osteosarcoma of limbs in children and young adults. The first study of the European Osteosarcoma Intergroup. J Clin Oncol. 1992; 10: 1579-1591.
|
Language: | English.
|
Document Type: | Article.
|
Journal Subset: | Clinical Medicine.
|
ISSN: | 0008-543X
|
DOI Number: | https://dx.doi.org/10.1002/cncr....- ouverture dans une nouvelle fenêtre
|
Annotation(s) | |
|
|