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Review of management issues in relapsed osteosarcoma
Nataraj Vijayamurugan1, Sameer Bakhshi
1Departments of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi-110029, India.
Expert Review of Anticancer Therapy
|December 7, 2013
Summary
Osteosarcoma, a common childhood bone cancer, has a 70% survival rate for localized disease. Relapsed patients, often with lung metastasis, can achieve cure through surgery and chemotherapy, with survival depending on disease-free interval and resection completeness.
Area of Science:
- Pediatric Oncology
- Skeletal Oncology
- Cancer Metastasis Research
Background:
- Osteosarcoma represents the most frequent primary malignant bone tumor in pediatric and adolescent populations.
- Current combined modality treatments yield approximately 70% long-term survival for localized osteosarcoma.
- A significant subset of patients (30%) experience relapse, most commonly with lung metastases.
Purpose of the Study:
- To review treatment strategies and prognostic factors for relapsed osteosarcoma, particularly in cases of lung metastasis.
- To evaluate the efficacy of surgical intervention and adjuvant chemotherapy in improving survival outcomes for recurrent osteosarcoma.
- To identify key indicators for predicting survival in patients with relapsed osteosarcoma.
Main Methods:
- Review of clinical data and treatment outcomes for pediatric and adolescent patients with relapsed osteosarcoma.
- Analysis of the impact of surgical resection (including repeated thoracotomies) on survival.
- Assessment of the role of chemotherapy in conjunction with surgery for achieving remission and improving prognosis.
Main Results:
- Surgery is the primary treatment modality for relapsed osteosarcoma, especially when feasible.
- Adjuvant chemotherapy significantly enhances survival for patients who do not achieve a second surgical remission.
- Even patients with multiple lung recurrences demonstrate potential for cure through repeated surgical interventions.
- Disease-free interval and the completeness of surgical resection are identified as critical prognostic factors for post-relapse survival.
Conclusions:
- Relapsed osteosarcoma, particularly with lung metastasis, remains a treatable condition in pediatric and adolescent patients.
- Aggressive surgical management, including repeat procedures, combined with chemotherapy, offers a curative potential.
- Optimizing disease-free intervals and ensuring complete surgical resection are paramount for improving outcomes in relapsed osteosarcoma patients.
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