title: Survival of pediatric patients after relapsed osteosarcoma: the St. Jude Children's Research Hospital experience.
abstract: BACKGROUND
  Chemotherapy has improved the outcome of patients with newly diagnosed osteosarcoma, but its role in relapsed disease is unclear.
  
  
  METHODS
  We reviewed the records of all patients who were treated for relapsed high-grade osteosarcoma at our institution between 1970 and 2004. Postrelapse event-free survival (PREFS) and postrelapse survival (PRS) were estimated, and outcome comparisons were made using an exact log-rank test.
  
  
  RESULTS
  The 10-year PREFS and PRS of the 110 patients were 11.8% ± 3.5% and 17.0% ± 4.3%, respectively. Metastasis at initial diagnosis (14%), and relapse in lung only (75%) were not significantly associated with PREFS or PRS. Time from initial diagnosis to first relapse (RL1) ≥18 months (43%), surgery at RL1 (76%), and ability to achieve second complete remission (CR2, 56%) were favorably associated with PREFS and PRS (P  ≤  0.0002). In patients without CR2, chemotherapy at RL1 was favorably associated with PREFS (P = 0.01) but not with PRS. In patients with lung relapse only, unilateral relapse and number of nodules ( ≤ 3) were associated with better PREFS and PRS (P  ≤  0.0005); no patients with bilateral relapse survived 10 years. The median PREFS after treatment with cisplatin, doxorubicin, methotrexate, and ifosfamide was 3.5 months (95% confidence interval, 2.1-5.2), and the median PRS was 8.2 months (95% confidence interval, 5.2-15.1).
  
  
  CONCLUSIONS
  Late relapse, surgical resection, and unilateral involvement (in lung relapse only) favorably impact outcome after relapse. Surgery is essential for survival; chemotherapy may slow disease progression in patients without CR2. These data are useful for designing clinical trials that evaluate novel agents.
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
authors.forename: Sarah E S
authors.initials: SE
authors.lastname: Leary
authors.forename: Amy W
authors.initials: AW
authors.lastname: Wozniak
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Billups
authors.forename: Jianrong
authors.initials: J
authors.lastname: Wu
authors.forename: Valerie
authors.initials: V
authors.lastname: McPherson
authors.forename: Michael D
authors.initials: MD
authors.lastname: Neel
authors.forename: Bhaskar N
authors.initials: BN
authors.lastname: Rao
authors.forename: Najat C
authors.initials: NC
authors.lastname: Daw
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000401:mortality* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008499:Medical Records; D060787:Neoplasm Grading; D012516:Osteosarcoma / Q000401:mortality* / Q000473:pathology; D012008:Recurrence; D012189:Retrospective Studies; D017678:Sex Distribution; D013714:Tennessee / Q000453:epidemiology; D055815:Young Adult
keywords: chemotherapy; osteosarcoma; outcome; prognostic factors; relapse; survival