title: Bone metastases in osteosarcoma patients treated with neoadjuvant or adjuvant chemotherapy: the Rizzoli experience in 52 patients.
abstract: BACKGROUND
  There have been no large-scale studies reporting the outcome of patients with osteosarcoma who first relapse with bone metastases, but there have been several case reports describing a much poorer prognosis for these patients than for those who relapse with lung metastases.
  
  
  METHODS
  We compared 52 patients with skeletal metastases as first relapse after neoadjuvant or adjuvant treatment for osteosarcoma of the extremity given at our institution between 1972 and 1999 with 371 contemporary patients treated with the same chemotherapy protocols, who first relapsed with lung metastases.
  
  
  RESULTS
  We found that the 52 patients with bone metastases had a higher rate of local recurrences (36% vs. 6%), a lower rate of remission (35% vs. 77%), and lower rates of 5-year event-free survival (11% vs. 27%) and overall survival (13% vs. 31%) (p < 0.01 for all comparisons).
  
  
  CONCLUSIONS
  The prognosis of patients who relapse with bone metastases--unless they have a single late-appearing metastasis--is worse than the prognosis of patients who first relapse with lung metastases. There was no difference in outcome between patients with single, resectable and late-appearing skeletal metastases and patients relapsing in the lung.
authors.affiliation: Section of Chemotherapy, Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy. gaetano.bacci@ior.it
authors.forename: Gaetano
authors.initials: G
authors.lastname: Bacci
authors.forename: Alessandra
authors.initials: A
authors.lastname: Longhi
authors.forename: Franco
authors.initials: F
authors.lastname: Bertoni
authors.forename: Antonio
authors.initials: A
authors.lastname: Briccoli
authors.forename: Michela
authors.initials: M
authors.lastname: Versari
authors.forename: Elettra
authors.initials: E
authors.lastname: Pignotti
authors.forename: Piero
authors.initials: P
authors.lastname: Picci
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary / Q000601:surgery; D008297:Male; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D012516:Osteosarcoma / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome