Related Experiment Video
Updated: Jul 12, 2025
Modeling Primary Bone Tumors and Bone Metastasis with Solid Tumor Graft Implantation into Bone
Published on: September 9, 2020
Impact of delay of local control in nonmetastatic extremity primary osteosarcoma
Hadeel Halalsheh1,2, Taleb Ismael1, Mohammad Boheisi3
1Department of Pediatric, King Hussein Cancer Center, Amman, Jordan.
Insights
Delaying local control (LC) in osteosarcoma patients, especially beyond 18 weeks, is linked to worse survival outcomes. Prompt LC is crucial for improving event-free survival and overall survival in these young patients.
Area of Science:
- Oncology
- Orthopedic Surgery
- Pediatric Oncology
Background:
- The impact of local control (LC) timing on osteosarcoma survival is not well-established.
- Osteosarcoma is a primary bone cancer predominantly affecting children and young adults.
Purpose of the Study:
- To evaluate the association between the delay of local control (LC) and survival outcomes in pediatric patients with nonmetastatic extremity osteosarcoma.
- To identify prognostic factors influencing event-free survival (EFS) and overall survival (OS) in osteosarcoma.
Main Methods:
- Retrospective analysis of 82 pediatric patients (≤18 years) with nonmetastatic extremity osteosarcoma.
- Data collected included demographics, disease characteristics, and outcomes (death, progression, relapse).
- Cox proportional hazards regression used for univariable and multivariable analyses to assess the impact of LC delay (≥18 weeks) and other factors on survival.
Main Results:
- A delay in LC (≥18 weeks) was significantly associated with worse EFS and OS on both univariable and multivariable analyses (p < .001).
- Progression before LC and poor histologic response were also independent predictors of worse EFS and OS.
- Male gender was associated with worse OS (p = .02). After excluding early progression, LC < 18 weeks was linked to better EFS (p = .03).
Conclusions:
- Delayed local control (≥18 weeks) negatively impacts survival outcomes in pediatric osteosarcoma patients.
- Prompt initiation of LC and achieving a good histologic response are crucial for improving patient prognosis.
- Further research with larger cohorts and longer follow-up is warranted to confirm these findings.
Introduction:
The timing of local control (LC) is not well studied in osteosarcoma. We assessed the impact of the delay of LC on the survival outcome of patients with osteosarcoma.
Methods:
We conducted a retrospective analysis of children (≤18 years) with nonmetastatic extremity primary osteosarcoma at King Hussein Cancer Center from January 2005 until March 2020. Patients' demographics, disease characteristics, and outcomes were collected. Events were defined as death, progression, or relapse. Cox proportional hazards regression was used for univariable and multivariable comparisons of different covariates.
Results:
Eighty-two patients were included; 41 (50%) were females; the median age was 12.5 years (range: 5.9-18). Sixty-four patients (78%) underwent LC by limb-salvage surgery. Fifteen patients (18%) had a delay of LC greater than or equal to 18 weeks. After a median follow-up of 54 months (range: 8-188), the 5-year event-free survival (EFS) and overall survival (OS) were 55.3% ± 5.8% and 66.6% ± 6%, respectively. On univariable analysis, LC greater than or equal to 18 weeks, progression before LC, amputation, and poor histologic response were associated with worse EFS (p = .007, .007, .006, .002) and OS (p = .01, .001, .006, .004). On multivariable analysis, LC greater than or equal to 18 weeks, progression before LC, and poor histologic response were associated with worse EFS (p < .001, .007, .002); and OS (p < .001, .007, .008). Male gender was associated with worse OS on univariable and multivariable analysis (both p = .02). After exclusion of patients with early progression before Week 11, good histologic response and LC less than 18 weeks were associated with better EFS (p = .04 and .03). While good histologic response was associated with better OS (p = .02), LC less than 18 weeks was not significant (p = .2).
Conclusions:
Our findings suggest that delay in LC could have an impact on the outcomes in patients with osteosarcoma. However, further investigations involving larger sample sizes and longer follow-up are necessary to fully comprehend the extent of this influence.
