title: Experience of pediatric osteosarcoma of the extremity at a single institution in Taiwan: prognostic factors and impact on survival.
abstract: OBJECTIVE
  To identify the prognostic factors and evaluate the impact of chemotherapy regimens on the outcomes of pediatric osteosarcoma of the extremities.
  
  
  METHODS
  Patients younger than 18 years and diagnosed with high-grade osteosarcoma of the extremities during the period between January 2004 and December 2011 were included for retrospective analysis. Demographic characteristics and tumor features were compared between nonmetastatic and metastatic patients. Univariate analyses of overall survival (OS) and progression-free survival (PFS) were performed to evaluate the efficacy of various chemotherapy regimens.
  
  
  RESULTS
  A total of 74 patients (58 with nonmetastatic and 16 with metastatic disease) were enrolled and treated with three protocols consisting of various cycles of high-dose methotrexate, adriamycin (doxorubicin), cisplatin, and high-dose ifosfamide (MACI regimens) during the 8-year study period. Presence of metastasis was inversely correlated with OS and PFS. Alkaline phosphatase levels at diagnosis and histologic response to preoperative chemotherapy were correlated with OS. Tumor size was correlated with PFS. The 5-year OS and PFS were 77 and 70 % for all patients, and 90.4 and 83.3 % for those with nonmetastatic osteosarcoma; and the rates were both 25 % in those with metastatic osteosarcoma. The chemotherapy regimens increased good response rates by 30 % and survival rates by 20 % compared to the outcomes in patients treated before 2004.
  
  
  CONCLUSIONS
  Poor prognostic factors for osteosarcoma in pediatric patients were identified under homogeneous surgical and chemotherapy schemes. The four-drug regimens consisting of MACI contributed to the remarkably increased good response rates and consequent improvement in the survival rates.
authors.affiliation: Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC, gyhung@vghtpe.gov.tw.
authors.forename: Giun-Yi
authors.initials: GY
authors.lastname: Hung
authors.forename: Hsiu-Ju
authors.initials: HJ
authors.lastname: Yen
authors.forename: Chueh-Chuan
authors.initials: CC
authors.lastname: Yen
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Chen
authors.forename: Paul Chih-Hsueh
authors.initials: PC
authors.lastname: Chen
authors.forename: Hung-Ta Hondar
authors.initials: HT
authors.lastname: Wu
authors.forename: Hong-Jen
authors.initials: HJ
authors.lastname: Chiou
authors.forename: Wan-Hui
authors.initials: WH
authors.lastname: Chang
authors.forename: Hsiu-E
authors.initials: HE
authors.lastname: Hsu
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005121:Extremities / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013624:Taiwan
chemical_list: D004317:Doxorubicin; D002945:Cisplatin; D007069:Ifosfamide; D008727:Methotrexate