Osteosarcoma relapse after combined modality therapy: an analysis of unselected patients in the Cooperative Osteosarcoma Study Group (COSS)
| Autor: | Gernot Jundt, Kurt Winkler, Rainer Maas, Heribert Jürgens, Wolfgang E. Berdel, Detlev Branscheid, Beate Kempf-Bielack, Jörn Treuner, G. Ulrich Exner, Knut Helmke, Rainer Kotz, Andreas Zoubek, Thomas Klingebiel, Michael Semik, Hartmut Kabisch, Mathias Kevric, Rudolf Schwarz, Ulrich Göbel, Stefan S. Bielack |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Recurrent osteosarcoma Time Factors Adolescent Bone Neoplasms Cohort Studies Risk Factors Biopsy Antineoplastic Combined Chemotherapy Protocols Overall survival medicine Combined Modality Therapy Humans Child Survival analysis Aged Osteosarcoma medicine.diagnostic_test business.industry Middle Aged medicine.disease Prognosis Survival Analysis Surgery Oncology Child Preschool Female Sarcoma Neoplasm Recurrence Local business Cohort study |
| Zdroj: | Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 23(3) |
| ISSN: | 0732-183X |
| Popis: | Purpose To evaluate the impact of patient, tumor, and treatment-related factors on outcome in unselected patients with recurrent osteosarcoma. Patients and Methods Five hundred seventy-six consecutive patients who had achieved a first complete surgical remission (CR) during combined-modality therapy on neoadjuvant Cooperative Osteosarcoma Study Group (COSS) protocols and then developed recurrent osteosarcoma were analyzed (median time from biopsy to relapse, 1.6 years; range, 0.1 to 14.3 years). There were 501 patients with metastases, 44 with local recurrences, and 31 with both. Metastases involved lungs (469 patients), bones (90 patients), and/or other sites (54 patients). Results After a median follow-up of 1.2 years for all patients and 4.2 years for survivors, actuarial overall survival (OS) rates at 2, 5, and 10 years were 0.38, 0.23, and 0.18, respectively. Five-year OS was 0.39 for 339 patients with and 0.00 for 229 patients without a second surgical CR (P < .0001). A long time to relapse, a solitary lesion, and, in the case of pulmonary metastases, unilateral disease and the absence of pleural disruption, were of positive prognostic value in uni- and multivariate analyses, as were a second surgical CR and the use of second-line chemotherapy. Radiotherapy was associated with moderately prolonged survival in patients without a second CR. The very limited prognostic differences associated with the use of second-line chemotherapy appeared to be more pronounced with polychemotherapy. Conclusion Time to relapse and tumor burden correlate with postrelapse outcome in osteosarcoma. Complete surgery is an essential component of curative second-line therapy. Chemotherapy, particularly chemotherapy with more than one agent, may contribute to limited improvements in outcome. |
| Databáze: | OpenAIRE |
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