title: Recurrences following primary osteosarcoma in adolescents and adults previously treated with chemotherapy.
abstract: In this retrospective analysis, we report on the detailed management of 33 recurrent osteosarcoma patients from a population of 81 adolescents and adults previously treated (between November 1979 and November 1998) at the La Timone Adults Hospital, for an extremity-localised osteosarcoma. The site of the first recurrence was limited to the lung in 24 patients (73%), was local in 4 patients (12%), at multiple sites in 4 patients (12%), and limited to the bone for 1 patient (3%). The median interval between the diagnosis of the primary osteosarcoma and the first recurrence was 16 months (range 4-108 months). For all patients, the treatment combined aggressive chemotherapy and surgical resection of the recurrences whenever possible. 19 patients (58%) achieved a second complete remission. The median follow-up time from the first recurrence was 18 months (range 4-150 months). For all patients, the median overall survival from first recurrence was 17 months (95% confidence interval (CI), 11-22 months) and the projected 3- and 5-year survival rates were 31.6 and 23.7%, respectively. Patients with a second complete remission had a better 5-year survival than patients without (44.6% versus 0%, P=0.001). The achievement of a second complete remission has an independent significant prognostic value for an improved survival. Aggressive surgery with the removal of recurrence sites combined with multi-agent chemotherapy can either cure patients with recurrent osteosarcoma or significantly prolong their survival.
authors.affiliation: Department of Medical Oncology, La Timone University Hospital, Blvd. J. Moulin 13385 Marseilles cedex 5, France. fduffaud@mail.ap-hm.fr
authors.forename: F
authors.initials: F
authors.lastname: Duffaud
authors.forename: L
authors.initials: L
authors.lastname: Digue
authors.forename: C
authors.initials: C
authors.lastname: Mercier
authors.forename: J P
authors.initials: JP
authors.lastname: Dales
authors.forename: M
authors.initials: M
authors.lastname: Baciuchka-Palmaro
authors.forename: F
authors.initials: F
authors.lastname: Volot
authors.forename: P
authors.initials: P
authors.lastname: Thomas
authors.forename: R
authors.initials: R
authors.lastname: Favre
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D012516:Osteosarcoma / Q000188:drug therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome