title: Fifteen Years' Experience of the Brazilian Osteosarcoma Treatment Group (BOTG): A Contribution from an Emerging Country.
abstract: OBJECTIVE
  Little information is available regarding the tumor features, prognostic factors, and treatment results in children and adolescents and young adults (AYAs) with osteosarcoma diagnosed in developing countries. We reviewed the results of three observational cohorts of osteosarcoma patients treated in an emerging country.
  
  
  METHODS
  A total of 604 patients below the age of 30 years with high-grade osteosarcoma were prospectively enrolled in the Brazilian Osteosarcoma Treatment Group (BOTG) studies III, IV, and V. Gender, age, time from onset of symptoms to diagnosis, primary tumor site, presence or absence of metastases at diagnosis, tumor size, type of surgery (limb-sparing or amputation), treatment protocol, and histological response were correlated with survival.
  
  
  RESULTS
  The estimated 5-year overall survival and event-free survival (EFS) rates for the 553 eligible patients were 49% and 39% respectively; of the 390 non-metastatic patients included in the total, overall- and event-free survival were 59% and 48% respectively. Metastases at diagnosis, primary tumor site, type of surgery, and histological response were significant predictors of overall survival and EFS in univariate and multivariate analysis, whereas tumor size and treatment protocol lost prognostic significance in multivariate analysis.
  
  
  CONCLUSIONS
  We report on the outcome of three consecutive studies for the treatment of osteosarcoma carried out in Brazil over 15 years. Although the survival rates presented are below those reported in current literature, it represents the result of a favorable experience gathered from the national collaborative work.
authors.affiliation: 1 Instituto de Oncologia Pediátrica/GRAACC-Universidade Federal de São Paulo , São Paulo, Brazil .
authors.forename: Antonio Sergio
authors.initials: AS
authors.lastname: Petrilli
authors.affiliation: 2 Hospital de Clínicas de Porto Alegre , Porto Alegre, Brazil .
authors.forename: Algemir Lunardi
authors.initials: AL
authors.lastname: Brunetto
authors.affiliation: 1 Instituto de Oncologia Pediátrica/GRAACC-Universidade Federal de São Paulo , São Paulo, Brazil .
authors.forename: Monica Dos Santos
authors.initials: Mdos S
authors.lastname: Cypriano
authors.affiliation: 3 Universidade de São Paulo , São Paulo, Brazil .
authors.forename: Alexandre Archanjo
authors.initials: AA
authors.lastname: Ferraro
authors.affiliation: 1 Instituto de Oncologia Pediátrica/GRAACC-Universidade Federal de São Paulo , São Paulo, Brazil .
authors.forename: Carla Renata Pacheco
authors.initials: CR
authors.lastname: Donato Macedo
authors.affiliation: 1 Instituto de Oncologia Pediátrica/GRAACC-Universidade Federal de São Paulo , São Paulo, Brazil .
authors.forename: Andreza Almeida
authors.initials: AA
authors.lastname: Senerchia
authors.affiliation: 4 Instituto da Criança-Universidade de São Paulo , São Paulo, Brazil .
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Almeida
authors.affiliation: 5 Hospital do Câncer A. C. Camargo , São Paulo, Brazil .
authors.forename: Cecilia Maria da
authors.initials: CM
authors.lastname: Costa
authors.affiliation: 6 Hospital do Câncer do Ceará , Ceará, Brazil .
authors.forename: Daniel
authors.initials: D
authors.lastname: Lustosa
authors.affiliation: 7 Santa Casa de Misericórdia de São Paulo , São Paulo, Brazil .
authors.forename: Maria Luiza
authors.initials: ML
authors.lastname: Borsato
authors.affiliation: 8 Sociedade Pernambucana de Combate ao Câncer , Pernambuco, Brazil .
authors.forename: Luiz Mario
authors.initials: LM
authors.lastname: Calheiros
authors.affiliation: 9 Sociedade de Oncologia da Bahia , Bahia, Brazil .
authors.forename: Jose Henrique Silva
authors.initials: JH
authors.lastname: Barreto
authors.affiliation: 10 Hospital Santa Marcelina de Sao Paulo , São Paulo, Brazil .
authors.forename: Sidnei
authors.initials: S
authors.lastname: Epelman
authors.affiliation: 11 Hospital Pediátrico Martagão Gesteira , Bahia, Brazil .
authors.forename: Eny
authors.initials: E
authors.lastname: Carvalho
authors.affiliation: 1 Instituto de Oncologia Pediátrica/GRAACC-Universidade Federal de São Paulo , São Paulo, Brazil .
authors.forename: Maria Teresa Seixas
authors.initials: MT
authors.lastname: Alves
authors.affiliation: 1 Instituto de Oncologia Pediátrica/GRAACC-Universidade Federal de São Paulo , São Paulo, Brazil .
authors.forename: Marcelo de Toledo
authors.initials: Mde T
authors.lastname: Petrilli
authors.affiliation: 12 Hospital do Câncer de Barretos , São Paulo, Brazil .
authors.forename: Valter
authors.initials: V
authors.lastname: Penna
authors.affiliation: 7 Santa Casa de Misericórdia de São Paulo , São Paulo, Brazil .
authors.forename: Pedro
authors.initials: P
authors.lastname: Pericles
authors.affiliation: 3 Universidade de São Paulo , São Paulo, Brazil .
authors.forename: Olavo Pires
authors.initials: OP
authors.lastname: de Camargo
authors.affiliation: 1 Instituto de Oncologia Pediátrica/GRAACC-Universidade Federal de São Paulo , São Paulo, Brazil .
authors.forename: Reynaldo Jesus
authors.initials: RJ
authors.lastname: Garcia-Filho On Behalf Of The Brazilian Osteosarcoma Treatment Group
keywords: cooperative group; emerging country; osteosarcoma; prognostic factors; survival