Effect of chemotherapy on survival of craniofacial osteosarcoma: a systematic review of 201 patients.
OBJECTIVE
To evaluate the possible value of chemotherapy in the treatment of craniofacial osteosarcoma (CFOS).


METHODS
In a systematic review, data of 201 patients (age, 36.6 +/- 19.0 years [mean +/- SD]) from 20 uncontrolled series on CFOS indexed in Medline and Excerpta Medica between 1974 and 1994 were pooled; 180 patients had undergone surgery. Various chemotherapy regimens had been given to 71 patients. Radiotherapy was used in 69 patients. All patients had data for overall survival, and 182 had data for disease-free survival analysis. Cumulative survival distributions were estimated by the product-limit method, and a multiple regression analysis was performed.


RESULTS
Patients' overall and disease-free survival rates were significantly improved by treatment with chemotherapy. This was confirmed for patients with complete surgical removal, as well as for those with incomplete removal of tumor. In a proportional hazards model, complete surgical removal and chemotherapy were independent significant factors for overall and disease-free survival. The effect of radiotherapy was insignificant. No prognostic factors could be identified among age groups, sex, and subsites.


CONCLUSIONS
Evidence exists that chemotherapy improves survival in CFOS. We advocate the adoption of the chemotherapy protocols used for OS of the long bones for CFOS.
Smeele
L E
LE
Department of Oral and Maxillofacial Surgery and Oral Pathology, Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands. pathol@azvu.nl
Kostense
P J
PJ
van der Waal
I
I
Snow
G B
GB
D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000188:drug therapy / Q000401:mortality; D008441:Maxillary Neoplasms / Q000188:drug therapy / Q000401:mortality; D012516:Osteosarcoma / Q000188:drug therapy* / Q000401:mortality*; D016016:Proportional Hazards Models; D012888:Skull Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D016896:Treatment Outcome