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Experience of Pediatric Osteosarcoma of the Extremity at a Single Institution in Taiwan: Prognostic Factors and Impact on Survival

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

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.

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Acknowledgment

The authors greatly appreciate the support of the Childhood Cancer Foundation, Taiwan, in data collection, validation, and statistical analysis.

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

    Giun-Yi Hung MD & Hsiu-Ju Yen MD

  2. Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

    Giun-Yi Hung MD, Hsiu-Ju Yen MD, Chueh-Chuan Yen MD, PhD, Wei-Ming Chen MD, Paul Chih-Hsueh Chen MD, Hung-Ta Hondar Wu MD & Hong-Jen Chiou MD

  3. School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC

    Giun-Yi Hung MD, Hsiu-Ju Yen MD, Chueh-Chuan Yen MD, PhD, Wei-Ming Chen MD, Paul Chih-Hsueh Chen MD, Hung-Ta Hondar Wu MD & Hong-Jen Chiou MD

  4. Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

    Chueh-Chuan Yen MD, PhD

  5. Department of Orthopedics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

    Wei-Ming Chen MD

  6. Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

    Paul Chih-Hsueh Chen MD

  7. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

    Hung-Ta Hondar Wu MD & Hong-Jen Chiou MD

  8. National Defense Medical Center, Taipei, Taiwan, ROC

    Hong-Jen Chiou MD

  9. Childhood Cancer Foundation, Taipei, Taiwan, ROC

    Wan-Hui Chang MS & Hsiu-E Hsu BN

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  1. Giun-Yi Hung MD
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  2. Hsiu-Ju Yen MD
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  3. Chueh-Chuan Yen MD, PhD
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  6. Hung-Ta Hondar Wu MD
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  7. Hong-Jen Chiou MD
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  8. Wan-Hui Chang MS
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  9. Hsiu-E Hsu BN
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Corresponding author

Correspondence to Giun-Yi Hung MD.

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Hung, GY., Yen, HJ., Yen, CC. et al. Experience of Pediatric Osteosarcoma of the Extremity at a Single Institution in Taiwan: Prognostic Factors and Impact on Survival. Ann Surg Oncol 22, 1080–1087 (2015). https://doi.org/10.1245/s10434-014-4154-z

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  • DOI: https://doi.org/10.1245/s10434-014-4154-z

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