title: Improvement in High-Grade Osteosarcoma Survival: Results from 202 Patients Treated at a Single Institution in Taiwan.
abstract: The aim of this study was to compare survival before and after 2004 and define the prognostic factors for high-grade osteosarcomas beyond those of typical young patients with localized extremity disease. Few studies have reported the long-term treatment outcomes of high-grade osteosarcoma in Taiwan. A total of 202 patients with primary high-grade osteosarcoma who received primary chemotherapy at Taipei Veterans General Hospital between January 1995 and December 2011 were retrospectively evaluated and compared by period (1995-2003 vs 2004-2011). Patients of all ages and tumor sites and those following or not following controlled protocols were included in analysis of demographic, tumor-related, and treatment-related variables and survival. Overall survival and progression-free survival at 5 years were, respectively, 67.7% and 48% for all patients (n = 202), 77.3% and 57.1% for patients without metastasis (n = 157), and 33.9% and 14.8% for patients with metastasis (n = 45). The survival rates of patients treated after 2004 were significantly higher (by 13%-16%) compared with those of patients treated before 2004, with an accompanying 30% increase in histological good response rate (P = .002). Factors significantly contributing to inferior survival in univariate and multivariate analyses were diagnosis before 2004, metastasis at diagnosis, and being a noncandidate for a controlled treatment protocol. By comparison with the regimens used at our institution before 2004, the current results support the effectiveness of the post-2004 regimens, which consisted of substantially reduced cycles of high-dose methotrexate and a higher dosage of ifosfamide per cycle, cisplatin, and doxorubicin, for treating high-grade osteosarcoma in Asian patients.
authors.affiliation: From the Department of Pediatrics, Division of Pediatric Hematology and Oncology (G-YH, H-JY); Department of Orthopedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital (G-YH, H-JY, C-CY, P-KW, C-FC, PC-HC, H-THW, H-JC, W-MC); School of Medicine, National Yang-Ming University (G-YH, H-JY, C-CY, C-FC, PC-HC, H-THW, H-JC, W-MC); Department of Life Science, National Taiwan Normal University (G-YH, H-JY); Department of Oncology, Division of Medical Oncology, Taipei Veterans General Hospital (C-CY); Institute of Clinical Medicine, National Yang-Ming University (P-KW); Department of Orthopedics (P-KW, C-FC); Department of Pathology (PC-HC); Department of Radiology (H-THW, H-JC); National Defense Medical Center (H-JC); and Rehabilitation and Technical Aid Center, Taipei Veterans General Hospital, Taipei, Taiwan (W-MC).
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: Po-Kuei
authors.initials: PK
authors.lastname: Wu
authors.forename: Cheng-Fong
authors.initials: CF
authors.lastname: Chen
authors.forename: Paul C-H
authors.initials: PC
authors.lastname: Chen
authors.forename: Hung-Ta H
authors.initials: HH
authors.lastname: Wu
authors.forename: Hong-Jen
authors.initials: HJ
authors.lastname: Chiou
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D012516:Osteosarcoma / Q000188:drug therapy* / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D015996:Survival Rate; D013624:Taiwan; D055815:Young Adult