title: De novo osteogenic sarcoma in patients older than forty: benefit of multimodality therapy.
abstract: The treatment of primary osteogenic sarcoma is well established in younger patients; however, controversy surrounds the treatment of this disease in the older population. To confirm multimodality therapy results in longer survival than surgery alone, 58 patients older than 40 years with primary osteogenic sarcoma were assessed retrospectively for the benefits of multimodality treatment versus surgery alone. We then asked whether specific patient and tumor characteristics and treatment modalities affected the rates of survival. Finally, we questioned whether pulmonary metastatectomy increased survival. The 5-year and 10-year overall survival for the group was 58% and 44%, respectively. Multimodality therapy increased survival compared with surgery alone in patients with high-grade disease. On multivariate analysis, considerable prognostic factors for improved overall survival for the entire group were age younger than 60 years, volume less than 100 cm, normal alkaline phosphatase, localized disease, negative surgical margins, and absence of recurrence. Pulmonary metastatectomy improved survival in selected patients.
  
  
  METHODS
  Therapeutic study, Level III-1 (retrospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Orthopedic Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Manoso
authors.forename: John H
authors.initials: JH
authors.lastname: Healey
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Boland
authors.forename: Edward A
authors.initials: EA
authors.lastname: Athanasian
authors.forename: Robert G
authors.initials: RG
authors.lastname: Maki
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Huvos
authors.forename: Carol D
authors.initials: CD
authors.lastname: Morris
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology / Q000628:therapy; D009364:Neoplasm Recurrence, Local; D012516:Osteosarcoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate