title: Metastatic osteosarcoma at diagnosis: prognostic factors and long-term outcome--the French pediatric experience.
abstract: BACKGROUND
  The objective of this report was to estimate long-term outcome and prognostic factors in children and adolescents who presented with metastatic osteosarcoma at diagnosis. Patients were treated in six French pediatric oncology centers with surgery and multiagent chemotherapy, mainly with high-dose methotrexate. Their medical records were reviewed retrospectively.
  
  
  METHODS
  The medical records of patients who were treated for metastatic osteosarcoma from 1987 to 2000 were reviewed. Patients were treated with the chemotherapy regimens recommended for nonmetastatic disease in children (the French Society of Pediatric Oncology OS 87 and OS 94 protocols) or, in a few patients, with other chemotherapy regimens. Surgical excision of the primary tumor and, when possible, of all metastatic sites was performed based on a personalized assessment of each patient's situation.
  
  
  RESULTS
  Seventy-eight patients age < 20 years were treated. Forty-six patients (59%) had only 1 metastatic site (35 to the lungs and 11 to bone). Twenty-eight patients (36%) achieved a complete remission after combination chemotherapy and surgery. The event-free survival and overall survival rates at 5 years were 14% and 19%, respectively. To date, 14 patients (18%) have remained alive with a median follow-up of 112 months. Pretreatment features associated with a shorter event-free survival in the multivariate analysis were metastasis to at least two organs and high alkaline phosphatase level. Patients with at least 1 of these poor prognostic factors had a 2.6% event-free survival rate at 5 years despite treatment.
  
  
  CONCLUSIONS
  The survival of patients with metastatic osteosarcoma were treated with conventional chemotherapy and surgery remained very poor. Patients should be classified into different prognostic groups and treated accordingly. New therapeutic approaches are warranted to improve the prognosis for patients with the most severe disease.
authors: Pediatrics Department, Leon Berard Center, Lyon, France. valerie.mialou@chu-lyon.fr
authors: Valerie
authors: V
authors: Mialou
authors: Thierry
authors: T
authors: Philip
authors: Chantal
authors: C
authors: Kalifa
authors: David
authors: D
authors: Perol
authors: Jean-Claude
authors: JC
authors: Gentet
authors: Perrine
authors: P
authors: Marec-Berard
authors: Helene
authors: H
authors: Pacquement
authors: Pascal
authors: P
authors: Chastagner
authors: Anne-Sophie
authors: AS
authors: Defaschelles
authors: Olivier
authors: O
authors: Hartmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D009364:Neoplasm Recurrence, Local; D012516:Osteosarcoma / Q000401:mortality / Q000473:pathology* / Q000556:secondary* / Q000628:therapy; D011379:Prognosis; D015996:Survival Rate
chemical_list: D000469:Alkaline Phosphatase