title: The patterns of relapse in osteosarcoma: the Memorial Sloan-Kettering experience.
abstract: BACKGROUND
  With the introduction of intensive high-dose chemotherapy for the treatment of osteosarcoma, changes in the pattern of metastases observed at relapse have been reported. To further investigate this hypothesis, the relapse patterns among groups receiving chemotherapy regimens of variable intensity at Memorial Sloan-Kettering Cancer Center were analyzed.
  
  
  METHODS
  All patients treated with the protocols T4, T5, T7, T10, and T12 were included. Patients were divided into two groups, one including those patients treated with less intense therapy (T4, T5, and T7) and the other, those treated with current regimens (T10 and T12).
  
  
  RESULTS
  Of the 25 patients who relapsed on the earlier protocols, 76% relapsed to the lungs, 8% had local recurrences, and 16% distant metastases to the bone. The median time to first relapse was 12 months. Of the 69 patients who relapsed on the T10 and T12 protocols, 75% relapsed in the lungs, 9% had local recurrences, and 16% distant bone metastases. The median time to first relapse was 17 months. There was no statistically significant difference in the timing of relapse between the two groups studied, although a longer median time to relapse was observed for patients treated on the later protocols. The range of time to relapse was also wider in the later protocols.
  
  
  CONCLUSIONS
  These data do not support the hypothesis that patterns of relapse are changing with alterations in osteosarcoma treatment. This limited single institutional experience can be explored further in the context of a multi-institutional effort.
authors.affiliation: Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
authors.forename: Susan N
authors.initials: SN
authors.lastname: Chi
authors.forename: Laurie S
authors.initials: LS
authors.lastname: Conklin
authors.forename: Jing
authors.initials: J
authors.lastname: Qin
authors.forename: Paul A
authors.initials: PA
authors.lastname: Meyers
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Huvos
authors.forename: John H
authors.initials: JH
authors.lastname: Healey
authors.forename: Richard
authors.initials: R
authors.lastname: Gorlick
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000556:secondary; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology; D012516:Osteosarcoma / Q000188:drug therapy* / Q000556:secondary; D012074:Remission Induction; D015996:Survival Rate; D016896:Treatment Outcome