title: Late relapse of osteosarcoma: implications for follow-up and screening.
abstract: Long-term disease-free survival in patients with localised osteosarcoma treated in large multicentre randomised trials is over 50%. Most relapses occur early, usually within 2-3 years. Relapse after 5 years is uncommon and has been infrequently described. Eight patients with osteosarcoma treated at The London Bone and Soft Tissue Tumour Service since 1986 developed recurrence of disease after 5 years, the latest 14 years after the initial diagnosis. Five patients developed pulmonary metastases, two patients isolated bone metastases and one patient intra-abdominal metastases. Although a second complete remission was achieved in six patients, four patients relapsed again, all with pulmonary metastases. Two patients had co-existent brain metastases. One of those with a second recurrence has achieved a further complete remission and remains well 50 months after the most recent treatment. A second patient is disease-free 24 months after complete excision of an isolated pulmonary metastasis and one further patient is disease-free 6 months after chemotherapy and pneumonectomy for pleural and pulmonary metastases. Five patients have died of disease with a median survival from the date of relapse of 17 months (2-68 months). Current data looking at long-term outcome of patients with osteosarcoma is limited. Reports of late relapse are rare as numbers are small, thus long-term surveillance of patients is essential. It is possible that sites of relapse are more unusual, and more extensive staging may be necessary when late relapse occurs.
authors.affiliation: The London Bone and Soft Tissue Tumour Service, Meyerstein Institute of Oncology, Middlesex Hospital, London, United Kingdom.
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Strauss
authors.forename: Anne
authors.initials: A
authors.lastname: McTiernan
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Whelan
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D009362:Neoplasm Metastasis; D012516:Osteosarcoma / Q000175:diagnosis* / Q000473:pathology*; D012008:Recurrence; D015996:Survival Rate; D013997:Time Factors