Management of osteosarcomas over one decade: the INCAN experience

Background

Osteosarcoma is the most common primary malignant bone tumour in children and young adults. Survival has improved from historic rates of <20% to current rates of 50%–75% with multimodality therapy. Despite advances in the diagnosis and management of osteosarcoma, there have been few recent studies describing the experiences of tertiary referral centers. We aim to describe and discuss the clinical features, management and outcomes of these patients in a single institution.

Materials and methods

Retrospective study of 100 consecutive patients managed for osteosarcoma at Instituto Nacional de Cancerologia (Distrito Federal, México) between 1985 and 1995. Survival curves were generated using the Kaplan-Meier and the log rank test.

Results

Median age at diagnosis was 21 (range, 13–70) years. Gender distribution was: 59 male and 41 female patients with a relation male-female 1.4–1. Pain was the most common presenting symptom in fifty-five patients (55%). Median tumor size was 15 cm. 55 patients (55%) had osteosarcoma in the femur, 22 in tibia, in the humerus 9 and others 14. At the diagnosis, 33 patients had metastatic disease, the highest rate was lung metastasis (79%) followed of bone metastasis (12%) The surgical resection was realized in 93 patients, with radical surgery in 62 patients and limb sparing 31 patients. All but twenty-four patients received chemotherapy; of patients who were administered chemotherapy, 33 patients received neoadjuvant chemotherapy and 43 adjuvant chemotherapy. In five patients received radiotherapy.

The median follow-up time for surviving patients was 44 months (range, 2–240) for the 10-year periods. Following initial therapy, over fifteen percent of patients remained relapse-free during the follow-up period. The median of survival for the patients with stage I of the American Joint Committee on Cancer (AJCC) was 103 months, II (72 months), III (92 months), IV (17 months) (P = 0.0019). The median of survival for the patients without or with metastasis was of 71 months vs 16 months (P = 0.001).

Conclusion

Patient outcomes can be optimized through a multidisciplinary approach in a tertiary referral centre. In the Instituto Nacional de Cancerologia survival and relapse rates of patients managed for osteosarcoma compare unfavourably with the published literature actually. A poor survival in this period of study reflected the lack of effective treatment as the chemotherapy. Our results in this period are comparable to the results of it period pre chemotherapy.