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Improvement in High-Grade Osteosarcoma Survival: Results from 202 Patients Treated at a Single Institution in Taiwan
Giun-Yi Hung1, Hsiu-Ju Yen, Chueh-Chuan Yen
1From the Department of Pediatrics, Division of Pediatric Hematology and Oncology (G-YH, H-JY); Department of Orthopedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital (G-YH, H-JY, C-CY, P-KW, C-FC, PC-HC, H-THW, H-JC, W-MC); School of Medicine, National Yang-Ming University (G-YH, H-JY, C-CY, C-FC, PC-HC, H-THW, H-JC, W-MC); Department of Life Science, National Taiwan Normal University (G-YH, H-JY); Department of Oncology, Division of Medical Oncology, Taipei Veterans General Hospital (C-CY); Institute of Clinical Medicine, National Yang-Ming University (P-KW); Department of Orthopedics (P-KW, C-FC); Department of Pathology (PC-HC); Department of Radiology (H-THW, H-JC); National Defense Medical Center (H-JC); and Rehabilitation and Technical Aid Center, Taipei Veterans General Hospital, Taipei, Taiwan (W-MC).
Abstract:
The aim of this study was to compare survival before and after 2004 and define the prognostic factors for high-grade osteosarcomas beyond those of typical young patients with localized extremity disease. Few studies have reported the long-term treatment outcomes of high-grade osteosarcoma in Taiwan. A total of 202 patients with primary high-grade osteosarcoma who received primary chemotherapy at Taipei Veterans General Hospital between January 1995 and December 2011 were retrospectively evaluated and compared by period (1995-2003 vs 2004-2011). Patients of all ages and tumor sites and those following or not following controlled protocols were included in analysis of demographic, tumor-related, and treatment-related variables and survival. Overall survival and progression-free survival at 5 years were, respectively, 67.7% and 48% for all patients (n = 202), 77.3% and 57.1% for patients without metastasis (n = 157), and 33.9% and 14.8% for patients with metastasis (n = 45). The survival rates of patients treated after 2004 were significantly higher (by 13%-16%) compared with those of patients treated before 2004, with an accompanying 30% increase in histological good response rate (P = .002). Factors significantly contributing to inferior survival in univariate and multivariate analyses were diagnosis before 2004, metastasis at diagnosis, and being a noncandidate for a controlled treatment protocol. By comparison with the regimens used at our institution before 2004, the current results support the effectiveness of the post-2004 regimens, which consisted of substantially reduced cycles of high-dose methotrexate and a higher dosage of ifosfamide per cycle, cisplatin, and doxorubicin, for treating high-grade osteosarcoma in Asian patients.
