Treatment algorithm for locally recurrent osteosarcoma based on local disease-free interval and the presence of lung metastasis.

التفاصيل البيبلوغرافية
العنوان:	Treatment algorithm for locally recurrent osteosarcoma based on local disease-free interval and the presence of lung metastasis.
المؤلفون:	Nathan SS; Department of Orthopaedics, Faculty of Medicine, National University of Singapore, Singapore, USA., Gorlick R, Bukata S, Chou A, Morris CD, Boland PJ, Huvos AG, Meyers PA, Healey JH
المصدر:	Cancer [Cancer] 2006 Oct 01; Vol. 107 (7), pp. 1607-16.
نوع المنشور:	Journal Article; Research Support, Non-U.S. Gov't
اللغة:	English
بيانات الدورية:	Publisher: Wiley Country of Publication: United States NLM ID: 0374236 Publication Model: Print Cited Medium: Print ISSN: 0008-543X (Print) Linking ISSN: 0008543X NLM ISO Abbreviation: Cancer Subsets: MEDLINE
أسماء مطبوعة:	Publication: <2005- >: Hoboken, NJ : Wiley Original Publication: New York [etc.] Published for the American Cancer Society by J. Wiley [etc.]
مواضيع طبية MeSH:	Bone Neoplasms/mortality , Bone Neoplasms/therapy , Lung Neoplasms/secondary , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/therapy , Osteosarcoma/mortality , Osteosarcoma/*therapy, Adolescent ; Adult ; Aged ; Aged, 80 and over ; Algorithms ; Bone Neoplasms/pathology ; Child ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology ; Osteosarcoma/pathology ; Survival Analysis
مستخلص:	Background: Local recurrence in osteosarcoma is clinically distinct from metastasis, although associated with a similar reduction in survival. The prognostic factors in locally recurrent osteosarcoma were investigated and these factors were translated into a management strategy. Methods: In all, 407 consecutive patients with skeletal osteosarcoma between 1977 and 2002 were analyzed. Twenty-three patients with resectable local recurrence were analyzed. Clinical and tumor-related factors were assessed for significance in relation to survival and a management strategy was formulated based on factors found to be independently significant for survival. Results: Seventeen of the 23 patients underwent primary resections and initial treatment, yielding an overall local recurrence rate of 4.2% for resectable cancer. Median time to local recurrence was 13 months (95% confidence interval, 9-16 months). The 5-year and 10-year survival rates in the recurrent cases were 29% and 10%, respectively. All patients received chemotherapy both for their primary and recurrent disease. Increased risk of local recurrence (P < .0001) was strongly correlated with positive margins of resection. The rate of local recurrence was not related to chemotherapy-associated necrosis in the primary tumor. Nevertheless, neoadjuvant therapy halved the risk of local recurrence (odds ratio, 1.92; P = .3, power 10%). The strongest correlate with poor survival was local recurrence within the first year after primary resection (P = .001), followed by metastasis at the time of first local recurrence (P = .04) and failure to achieve clinical remission after disease recurrence (P = .04). Chemotherapy-associated necrosis and margins of resection of the primary tumor were not significant prognostic variables for survival. Survival differed significantly among patients defined by local disease-free interval and lung metastasis (P = .0001). They required an individualized approach as captured in the management algorithm. Conclusion: There is a residual risk of local recurrence in patients despite favorable chemotherapy-associated necrosis and negative margins of resection. A treatment strategy emphasizing clinical remission at all identifiable sites offers the highest likelihood of survival in this patient population. ((c) 2006 American Cancer Society.)
تواريخ الأحداث:	Date Created: 20060826 Date Completed: 20061106 Latest Revision: 20061115
رمز التحديث:	20231215
DOI:	10.1002/cncr.22197
PMID:	16933325
قاعدة البيانات:	MEDLINE

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تدمد:	0008-543X
DOI:	10.1002/cncr.22197