Survival of pediatric patients after relapsed osteosarcoma: The St. Jude Children’s Research Hospital experience

Abstract

10516 Background: The use of chemotherapy has improved the outcome of patients with newly-diagnosed osteosarcoma, but its role in relapsed disease is unclear. Methods: We retrospectively reviewed the records of all patients who were treated for relapsed high- grade osteosarcoma at St. Jude Children’s Research Hospital between 1970 and 2004. Post-relapse event-free survival (PREFS) and post-relapse survival (PRS) were estimated using Kaplan-Meier method and comparisons were made using the exact log-rank test. Results: One hundred ten patients were treated for first relapse (RL1) of high-grade osteosarcoma after primary treatment with surgery and chemotherapy. Median age at initial diagnosis was 14.2 years; 56% were male and 75% were Caucasian. Most tumors (95%) arose in the extremity. Ten-year PRS and PREFS were 18% ± 4.5% and 12% ± 3.5%, respectively. Age, race, gender, metastasis at initial diagnosis (14%), and relapse in lung only (75%) did not significantly correlate with PREFS or PRS (p>0.1). Time from initial diagnosis to RL1 ≥ 18 months (42%), surgery at RL1 (75%), and ability to achieve a second complete remission (CR2) (56%) were favorably associated with PRS and PREFS (p<0.0001). In the 48 patients who did not achieve CR2, use of chemotherapy at RL1 was favorably associated with PREFS (p=0.005) but not with PRS (p=0.8). Median PREFS for the 38 patients who had a failure at any point after receiving four active chemotherapy agents (cisplatin, doxorubicin, ifosfamide, and methotrexate) was 3.7 months (95% CI, 2.2–5.2) and median PRS was 8.2 months (95% CI, 5.7–15.1). Conclusions: The outcome of patients with relapsed osteosarcoma is poor. Late relapse and surgical resection are positive predictors of survival. Chemotherapy may slow disease progression in patients with unresected tumors. Our data is useful for the design of clinical trials that evaluate novel agents, which are desperately needed in this patient population. No significant financial relationships to disclose.