دورية أكاديمية
Treatment algorithm for locally recurrent osteosarcoma based on local disease-free interval and the presence of lung metastasis.
العنوان: | Treatment algorithm for locally recurrent osteosarcoma based on local disease-free interval and the presence of lung metastasis. |
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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 |
تدمد: | 0008-543X |
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DOI: | 10.1002/cncr.22197 |