Long-term outcome after polychemotherapy and intensive local radiation therapy of high-grade osteosarcoma.
BACKGROUND
Current standard therapy for high-grade osteosarcoma is neoadjuvant chemotherapy and complete resection of the primary tumour. Irradiation can improve local control if complete tumour resection is not possible or refused, but data on long-term outcome are not available.


METHODS
We report on long-term results for overall survival, occurrence of local recurrence and metastasis, joint function and side-effects in 13 patients with high-grade osteosarcoma having been treated with a combination of local irradiation and polychemotherapy (median follow-up of 13.5 years).


RESULTS
Ten of the 13 patients were alive 4-23 years after diagnosis. Three patients suffered local recurrence, in 2 of them tumour control and long-term survival could be achieved by secondary salvage surgery and polychemotherapy. In 5 patients pathological fractures of the irradiated bones occurred, none of them was associated with local recurrence. In 7 of the 10 long-term survivors good or fair joint function was achieved.


CONCLUSIONS
We conclude that combination of chemotherapy and intensive local irradiation can achieve long-term local control and even cure in high-grade osteosarcoma. Thus radiation therapy may represent an alternative to definite surgery in selected patients, in particular in those with good response to chemotherapy, when surgery is not feasible or refused.
Hundsdoerfer
Patrick
P
Department of Paediatric Oncology/Haematology, Charité Universitätsmedizin, Augustenburger Platz 1, Berlin 13353, Germany. patrick.hundsdoerfer@charite.de
Albrecht
Marion
M
Rühl
Ursula
U
Fengler
Rüdiger
R
Kulozik
Andreas E
AE
Henze
Günter
G
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D002648:Child; D005260:Female; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D012516:Osteosarcoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D011379:Prognosis; D011879:Radiotherapy Dosage; D017741:Survivors; D016896:Treatment Outcome; D055815:Young Adult