Survival after Second and Subsequent Recurrences in Osteosarcoma: A Retrospective Multicenter Analysis

Area of Science:

• Oncology
• Orthopedic Surgery
• Cancer Research

Background:

• Osteosarcoma (OS) is the most common primary bone cancer.
• Despite treatment, 30-35% of OS patients experience recurrence.
• Survival after OS recurrence, especially a second relapse, is generally poor.

Purpose of the Study:

• To identify factors influencing post-relapse survival (PRS) after a second OS relapse.
• To analyze outcomes in patients with recurrent extremity osteosarcoma.

Main Methods:

• Retrospective analysis of 60 patients with a second OS relapse.
• Data collected from two Italian centers between 2003 and 2013.
• Evaluation of treatment strategies and survival outcomes.

Main Results:

• A second OS relapse occurred after a median disease-free interval (DFI) of 6 months.
• Pulmonary metastases were present in 76% of patients.
• Five-year survival after the second relapse was 22%.
• Isolated lung disease (33.6% 5-year survival) and a single pulmonary lesion (42% 5-year survival) correlated with better outcomes.
• Achieving a second complete surgical remission (CSR) resulted in 33.4% 5-year survival.
• Chemotherapy benefited patients without a third CSR (p<0.001).

Conclusions:

• Aggressive, repeated surgical intervention is vital for improving survival in recurrent OS.
• Key factors influencing survival include lung-only metastases, lesion count, DFI, and CSR.
• Chemotherapy remains important for patients ineligible for further surgery.