Neoadjuvant chemotherapy for adult osteosarcoma: Results of long term follow-up

Abstract

10543 Background: Neoadjuvant and adjuvant chemotherapy for treatment of osteosarcoma has significantly improved survival rates and rates of limb sparing surgery in the adult population. We present results of 65 adult patients with metastatic and nonmetastatic osteosarcoma treated at our institution over the last 21 years, with median follow-up of 8 years (range 1 to 21 years). Methods: All patients > 14 years treated for osteosarcoma at our institution were identified from the institutional histology database & records reviewed. Results: 80% of patients were male, with a median age of 20 years at diagnosis (range 14 to 71). The site of primary was the femur in 36 patients (55%), the tibia in 11 patients (17%), the humerus in 5 patients (8%); other sites included the ulna, scapula, maxilla, pelvis & calcaneum. 58 patients (89%) had neo-adjuvant chemotherapy with combination of cisplatin / doxorubicin alternating with high-dose methotrexate. 27 patients (42%) had tumour necrosis > 80% and received the same treatment postoperatively. Patients with poor tumour necrosis received VP16/ifosfamide postoperatively. 47 patients (72%) had limb sparing surgery. 8 patients (12%) developed local recurrence at a median time of 18 months (2 to 72). Of these, 3 patients (37%) went on to develop distant metastases. 11 patients in total (17%) developed distant metastases at a median time of 24 months (range: 12 to 48 months). 7 patients underwent resection of pulmonary metastases, of these 3 (43%) were alive and disease free at last follow-up. 56 patients (86%) had localised disease at presentation. Of these patients, 41 (73%) were alive and disease free at last follow-up. 8 patients (12%) had metastatic disease at presentation; of these 2 (25%) were alive and disease free at last follow-up. There was one treatment-related death; no cases of doxorubicin induced cardiomyopathy were identified. Conclusions: At a median follow-up of 8 years, no cases of local or distant recurrence were identified beyond 6 years. With pre- and postoperative chemotherapy, a cure rate of >70% for adult patients with localised disease was confirmed with long term follow-up. The combination of aggressive chemotherapy and surgical resection of metastatic disease resulted in a long term survival rate of 25% for patients presenting with distant metastases. No significant financial relationships to disclose.