title: Postrelapse survival in osteosarcoma of the extremities: prognostic factors for long-term survival.
abstract: OBJECTIVE
  To identify factors that influence postrelapse survival (PRS) in patients with nonmetastatic osteosarcoma of the extremity.
  
  
  METHODS
  One hundred sixty-two patients with recurrent osteosarcoma of the extremity were retrospectively reviewed. The first-line treatment included surgery of the primary lesion and chemotherapy with methotrexate, doxorubicin, cisplatin, and ifosfamide.
  
  
  RESULTS
  The projected 5-year PRS rate was 28%. Patients who had complete surgery of recurrence had a 5-year PRS of 39%, whereas for those who did not have complete surgery, PRS was 0% at 3 years (P <.0001). In the latter group, PRS was not influenced by site of recurrence and relapse-free interval (RFI), although it was influenced (P =.006) by the use of second-line chemotherapy (PRS, 53% at 12 months for patients who received chemotherapy v 12% for those who did not). In patients who had complete surgery, PRS was influenced by site of relapse (5-year PRS, lung 44%, other 19%; P <.06), RFI (5-year PRS at < or = 24 months, 20%; at > 24 months, 60%; P <.0001), and number of lung metastases (5-year PRS, two or fewer nodules, 59%; more than two nodules, 14%; P <.0001) but not by the use of a second-line chemotherapy treatment.
  
  
  CONCLUSIONS
  RFI, site of metastases, and number of pulmonary nodules are the main prognostic factors for PRS in osteosarcoma. Complete surgery of recurrence is pivotal in the strategy of treatment. Patients with unresectable recurrence benefit from second-line chemotherapy, whereas our data do not support a generalized use of chemotherapy after complete surgery of first recurrence.
authors.affiliation: Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy. stefano.ferrari@ior.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferrari
authors.forename: Antonio
authors.initials: A
authors.lastname: Briccoli
authors.forename: Mario
authors.initials: M
authors.lastname: Mercuri
authors.forename: Franco
authors.initials: F
authors.lastname: Bertoni
authors.forename: Piero
authors.initials: P
authors.lastname: Picci
authors.forename: Amelia
authors.initials: A
authors.lastname: Tienghi
authors.forename: Adalberto Brach
authors.initials: AB
authors.lastname: Del Prever
authors.forename: Franca
authors.initials: F
authors.lastname: Fagioli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Comandone
authors.forename: Gaetano
authors.initials: G
authors.lastname: Bacci
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012516:Osteosarcoma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents