Osteosarcoma in pediatric and young adult patients: The Singapore experience

Abstract

e21522 Background: There is limited information on treatment and survival regarding these tumors in the South East Asia region. We thus attempted to investigate the incidence, the treatment modalities used and the outcome of OS patients treated at the two major pediatric oncology hospitals in Singapore. Methods: A comprehensive list of patients with OS treated at the Department of Pediatrics National University Hospital and KK Women's and Children's Hospital, Singapore between April 1980 and May 2006 was generated. During the study interval, patients received neoadjuvant chemotherapy followed by definitive surgery consisting of either limb-salvage or amputation followed by adjuvant chemotherapy. Chemotherapy included combination of cisplatin and doxorubicin as per the European Osteosarcoma InterGroup (EOI) and as per the Memorial Sloan-Kettering Cancer Center's (MSKCC) T12 protocols. Treatment of subsequent relapses consisted of various combinations of methotrexate, ifosfamide, etoposide, other, and/or surgery. Results: Of the total 49 patients with OS, 14 (29%) patients presented with metastatic OS (lungs, n=13; skip lesion, n=1). The median age of diagnosis of OS was 12.4 (range, 6.6 - 17.9 years). Mean survival after diagnosis of OS was 13.4 years (95% CI, 9.1 - 17.8 years). The two and five-year overall survival were 56.4 % ± 86.9 % (se) and 37.5 % ± 73.9 % (se) respectively for the entire cohort. The two and five-year overall survival were 77.9 % ± 100 % (se) for patients who were treated as per the MSKCC T12 protocols. The two and five-year overall survival were 51.8 % ± 86.2 % (se) and 33.8 % ± 72.6 % respectively for patients who were treated as per the EOI regimen. Conclusions: Survival from OS in Singapore appears to be improving since the multi-drug combination chemotherapy was introduced in 2002. The rarity and complexity of OS makes it crucial for patients diagnosed with this tumor to seek a centralized multi-disciplinary Musculoskeletal Oncology team. No significant financial relationships to disclose.