J Korean Bone Joint Tumor Soc.  2012 Dec;18(2):59-65. 10.5292/jkbjts.2012.18.2.59.

Effect of Preoperative Chemotherapy on Survival in High-grade Localized Osteosarcoma of the Extremity

• Choi ES
• Han I
• Cho HS
• Kim HS

• KMID: 1431671
• DOI: http://doi.org/10.5292/jkbjts.2012.18.2.59

Abstract

PURPOSE
Multidisciplinary approaches of surgical resection and chemotherapy have been widely used for the treatment of non-metastatic osteosarcomas. We aimed to assess the effect of neoadjuvant chemotherapy for metastasis and disease-specific survival.
MATERIALS AND METHODS
Authors retrospectively reviewed 225 young (<30 years old) and non-metastatic osteosarcoma patients who underwent surgical resection and postoperative chemotherapy between February 1984 and July 2010. Mean age was 14.4 years old (ranged: 4-29 years old) and average follow-up period was 9.1 years (2-28 years). The patients were divided into two groups according to the application of preoperative chemotherapy. Both groups were compared with clinical characteristics, metastasis-free survival and disease-specific survival.
RESULTS
All of 225 patients, 32 patients were treated with postoperative chemotherapy and 193 patients were performed preoperative and postoperative chemotherapy. Postoperative chemotherapy group showed significantly high rate of amputation (p<0.001). Metastasis was occurred in 101 patients. Postoperative chemotherapy group indicated significant higher rate of metastasis (69% vs 41%, p=0.004) and early development of metastasis (mean: 11.5 vs 20.3 months, p=0.045) than pre-and postoperative chemotherapy group. Fifty-seven patients were died of osteosarcoma. Postoperative chemotherapy group revealed significant lower rate of 5-year disease-specific survival than pre-and postoperative chemotherapy group (51% vs 84%, p=0.001). Adult (>15 years) and large sized tumor (>8 cm) were meaningful risk factors of metastasis and disease-specific survival. Although, local recurrences were occurred in 13 patients, there was no significant difference.
CONCLUSION
Neoadjuvant chemotherapy offers better disease-specific survival and metastasis-free survival.

Keyword

osteosarcoma; chemotherapy; preoperative chemotherapy; survival

MeSH Terms

Adult
Amputation
Extremities
Follow-Up Studies
Humans
Neoplasm Metastasis
Osteosarcoma
Recurrence
Retrospective Studies
Risk Factors

Figure

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  Figure 1 (A) Kaplan-Meier method and Mantel-Cox test showed that metastasis free survival rate was higher in neoadjuvant and adjuvant chemotherapy group than adjuvant chemotherapy group. (B) Graph about the time to metastasis from surgery revealed that metastasis occurred earlier in adjuvant chemotherapy group than neoadjuvant and adjuvant chemotherapy group.

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  Figure 2 Kaplan-Meier method and Mantel-Cox test of disease-specific survival indicated that survival rate of neoadjuvant and adjuvant chemotherapy group was significantly higher than adjuvant chemotherapy group (p=0.001).

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  Figure 3 Comparison of metastasis-free and disease-specific survival about the patients who were treated in 1980's. (A) Kaplan-Meier method and Mantel-Cox test of metastasis-free survival indicated that survival rate of neoadjuvant and adjuvant chemotherapy group was significantly higher than adjuvant chemotherapy group (p=0.009). (B) Disease-specific survival was higher in neoadjuvant and adjuvant chemotherapy group, also (p=0.011).

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