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Osteogenic sarcoma with clinically detectable metastasis at initial presentation

P A Meyers1, G Heller, J H Healey

  • 1Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
|March 1, 1993
PubMed
Summary
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For osteosarcoma (OS) with metastasis, survival is poor despite chemotherapy. Complete surgical resection of all tumor sites is essential for survival in these patients.

Area of Science:

  • Orthopedic Oncology
  • Skeletal Metastasis
  • Cancer Research

Background:

  • Osteosarcoma (OS) treatment has improved survival for non-metastatic cases.
  • Patients with clinically detectable metastasis at diagnosis face a significantly poorer prognosis.
  • Understanding prognostic factors and surgical impact is crucial for metastatic OS.

Purpose of the Study:

  • To identify prognostic factors in patients with metastatic osteosarcoma.
  • To evaluate the effect of surgery on primary and metastatic sites in metastatic OS.
  • To assess outcomes for osteosarcoma presenting with metastasis.

Main Methods:

  • Retrospective review of 62 previously untreated patients with metastatic OS (1975-1984).
  • Intensive chemotherapy regimens including high-dose methotrexate and BCD (bleomycin, cyclophosphamide, dactinomycin); cisplatin used selectively.

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  • Surgical goal: complete resection of the primary tumor and all metastatic disease.

    • Main Results:

    • Overall survival was poor (11% survival, 20-month median).
    • Preoperative chemotherapy vs. immediate surgery did not impact survival.
    • Survival correlated with age, metastasis location, histologic response, and completeness of surgical resection.
    • Complete resection of all identified tumor sites was necessary for survival.

    Conclusions:

    • Osteosarcoma with metastasis has a very poor prognosis despite current therapies.
    • Aggressive surgical resection of all tumor sites is critical for survival in metastatic OS.
    • Novel therapeutic approaches at initial presentation are warranted for this patient group.