Abstract
Four decades ago, specialized chemotherapy regimens turned osteosarcoma, once considered a uniformly fatal disease, into a disease in which a majority of patients survive. Though significant survival gains were made from the 1960s to the 1980s, further outcome improvements appear to have plateaued. This study aims to comprehensively review all significant, published data regarding osteosarcoma and outcome in the modern medical era in order to gauge treatment progress. Our results indicate that published survival improved dramatically from 1960s to 1980s and then leveled, or in some measures decreased. Recurrence rates decreased in the 1970s and then leveled. In contrast, published limb salvage rates have increased significantly every recent decade until the present. Though significant gains have been made in the past, no improvement in published osteosarcoma survival has been seen since 1980, highlighting the importance of a new strategy in the systemic management of this still very lethal condition.
Highlights
Osteosarcoma was once considered such a fatal condition that early studies measured outcome in terms of “months to metastasis” rather than actual survival
Among the series of nonmetastatic, high-grade osteosarcoma patients, the most commonly measured statistic, 5-year overall survival (OS) was measured in 47,227 patients throughout the series
Ten-year OS increased by 37.6% from the 1960s to the 1970s (P < 0.0001), but showed no difference when comparing the 2000s to the 1990s (P = 0.28) (Figure 2)
Summary
Osteosarcoma was once considered such a fatal condition that early studies measured outcome in terms of “months to metastasis” rather than actual survival. After the turn of the last century, Coventry measured osteosarcoma survival at 5% [1]. In the 1950s, neither surgery, nor radiation, nor rudimentary chemotherapy regimens significantly impacted survival, with the largest study of the decade citing a 22% 5year survival [1]. With the advent of higher dose, multiagent chemotherapy regimens, 5-year survival steadily increased to as high as 81.6% in the 1970s [2]. Casual inspection of published data indicates that since the 1970s, survival and perhaps other outcome measures have yet to further improve. As surgical techniques and implants have evolved, chemotherapeutic agents used today seem to be wholly similar to those used thirty years ago
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