Abstract
BackgroundRecently, the number of osteosarcomas in middle-aged and older patients has demonstrated an increasing trend; moreover, their results are comparatively worse than those of young patients. In Europe and the USA, the prognosis for osteosarcoma in middle-aged and older patients has improved with adjuvant chemotherapy. In Japan, however, the prognosis has remained poor.Materials and MethodsWe retrospectively analyzed the outcomes of osteosarcoma, especially in regards to preoperative chemotherapy, from January 1980 to July 2014. A total of 29 patients with high-grade osteosarcoma between the age of 40 and 65 years were included. We included patients without distant metastasis and with primary lesions that were deemed resectable. The mean age was 52.8 years (range 41–65 years), and the mean follow-up period was 103.2 months (range 5–314 months).ResultsAdjuvant chemotherapy was administered to 27 of 29 patients (93%), and 8 of 15 cases (53%) were able to undergo preoperative chemotherapy as planned, including CDDP. A major complication of chemotherapy was acute kidney injury due to CDDP (26%). The 5-year OS and 5-year EFS were 64.9% and 57.1%, respectively. After 2006, a policy to prioritize the resection of the primary lesion was implemented, and if the primary lesion was deemed resectable, preoperative chemotherapy was either not administered or administered for only a short duration. The 5-year OS after 2006 improved to 78.8%.ConclusionsThis study shows that administration of high-dose intensity preoperative chemotherapy was difficult in middle-aged and older patients due to their high rate of acute kidney injury by CDDP. For cases of osteosarcoma in middle-aged and older patients, if the primary lesion is resectable, preoperative chemotherapy should be minimized to prioritize the resection of the primary lesion. It was considered that, with appropriate measures to prevent complications, adjuvant chemotherapy may lead to improved prognosis.Level of evidenceV.
Highlights
Most cases of osteosarcoma occur in young patients, in recent years, both the percentage and total number of middle-aged and older patients over the age of 40 years have demonstrated an upward trend.Hayakawa et al J Orthop Traumatol (2020) 21:13That is to say, according to the Bone Tumor Registry of Japan, 45 of 162 middle-aged osteosarcoma cases (27.8%) were registered in 2006, while 69 of 207 cases (33.3%) were registered by 2013, accounting for approximately 30% of all cases [1]
This study shows that administration of high-dose intensity preoperative chemotherapy was difficult in middle-aged and older patients due to their high rate of acute kidney injury by CDDP
For cases of osteosarcoma in middle-aged and older patients, if the primary lesion is resectable, preoperative chemotherapy should be minimized to prioritize the resection of the primary lesion
Summary
Most cases of osteosarcoma occur in young patients, in recent years, both the percentage and total number of middle-aged and older patients over the age of 40 years have demonstrated an upward trend.Hayakawa et al J Orthop Traumatol (2020) 21:13That is to say, according to the Bone Tumor Registry of Japan, 45 of 162 middle-aged osteosarcoma cases (27.8%) were registered in 2006, while 69 of 207 cases (33.3%) were registered by 2013, accounting for approximately 30% of all cases [1]. Most cases of osteosarcoma occur in young patients, in recent years, both the percentage and total number of middle-aged and older patients over the age of 40 years have demonstrated an upward trend. Middle-aged and older patients are excluded from clinical trials of chemotherapy for osteosarcoma because patients in these age groups may not be able to endure intensive chemotherapy compared with young patients. Since adequate chemotherapy cannot be administered for osteosarcoma in middle-aged and older patients, many studies have reported that their prognosis is poorer compared with that of younger patients [8–20]. The number of osteosarcomas in middle-aged and older patients has demonstrated an increasing trend; their results are comparatively worse than those of young patients. In Europe and the USA, the prognosis for osteosarcoma in middle-aged and older patients has improved with adjuvant chemotherapy.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
