Neurosurgical Review

, Volume 40, Issue 3, pp 449–460 | Cite as

Multimodal treatment of craniofacial osteosarcoma with high-grade histology. A single-center experience over 35 years

  • Marton König
  • Terje A. Osnes
  • Ingvild Lobmaier
  • Bodil Bjerkehagen
  • Øyvind S. Bruland
  • Kirsten Sundby Hall
  • Torstein R. Meling
Original Article
  • 136 Downloads

Abstract

High-grade craniofacial osteosarcoma (CFOS) is an aggressive malignancy with a poor prognosis. Our goals were to evaluate treatment outcomes in those treated at a single referral institution over 35 years and to compare our results to the available literature. A retrospective analysis of all 42 patients treated between 1980 and 2015 at Oslo University Hospital, Norway, identified in a prospectively collected database, was conducted. Mean follow-up was 79.6 months. Overall survival at 2 and 5 years was 70.5 and 44.7%, respectively. The corresponding disease-specific survival rates were 73.0 and 49.8%. Treatment was surgery only in eight cases. Additional therapy was administered in 34 patients: chemotherapy in nine, radiotherapy in seven, and a combination of these in 18 cases. Stratified analysis by resection margins demonstrated significantly better survival at 2 and 5 years after radical surgical treatment. Neoadjuvant chemotherapy and subsequent adequate surgery resulted in better survival than surgery alone. Half of the patients either had a primary or familial cancer predisposition. This is the largest single-center study conducted on high-grade CFOS to date. Our experience indicates that neoadjuvant chemotherapy with complete surgical resection significantly improved survival, compared to surgery alone.

Keywords

Osteosarcoma Surgical resection Craniofacial bones Multidisciplinary approach Multimodal treatment Survival 

References

  1. 1.
    Hogendoorn PC, Group EEW, Athanasou N, Bielack S, De Alava E, Dei Tos AP et al (2010) Bone sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v204–v213CrossRefPubMedGoogle Scholar
  2. 2.
    Mirabello L, Troisi RJ, Savage SA (2009) International osteosarcoma incidence patterns in children and adolescents, middle ages and elderly persons. Int J Cancer 125(1):229–234CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Fletcher C, Bridge J, Hogendoorn PC, Mertens F (2013) WHO classification of tumours of soft tissue and bone, 4th edn. International Agency for Research on Cancer, LyonGoogle Scholar
  4. 4.
    Berner K, Johannesen TB, Berner A, Haugland HK, Bjerkehagen B, Bohler PJ et al (2015) Time-trends on incidence and survival in a nationwide and unselected cohort of patients with skeletal osteosarcoma. Acta Oncol 54(1):25–33CrossRefPubMedGoogle Scholar
  5. 5.
    Tran LM, Mark R, Meier R, Calcaterra TC, Parker RG (1992) Sarcomas of the head and neck. Prognostic factors and treatment strategies. Cancer 70(1):169–177CrossRefPubMedGoogle Scholar
  6. 6.
    Saeter G, Bruland OS, Folleras G, Boysen M, Hoie J (1996) Extremity and non-extremity high-grade osteosarcoma—the Norwegian Radium Hospital experience during the modern chemotherapy era. Acta Oncol 35(Suppl 8):129–134CrossRefPubMedGoogle Scholar
  7. 7.
    Thiele OC, Freier K, Bacon C, Egerer G, Hofele CM (2008) Interdisciplinary combined treatment of craniofacial osteosarcoma with neoadjuvant and adjuvant chemotherapy and excision of the tumour: a retrospective study. Br J Oral Maxillofac Surg 46(7):533–536CrossRefPubMedGoogle Scholar
  8. 8.
    Berner K, Hall KS, Monge OR, Weedon-Fekjaer H, Zaikova O, Bruland OS (2015) Prognostic factors and treatment results of high-grade osteosarcoma in Norway: a scope beyond the “classical” patient. Sarcoma 2015:516843PubMedPubMedCentralGoogle Scholar
  9. 9.
    Luetke A, Meyers PA, Lewis I, Juergens H (2014) Osteosarcoma treatment—where do we stand? A state of the art review. Cancer Treat Rev 40(4):523–532CrossRefPubMedGoogle Scholar
  10. 10.
    Huvos AG, Rosen G, Marcove RC (1977) Primary osteogenic sarcoma: pathologic aspects in 20 patients after treatment with chemotherapy en bloc resection, and prosthetic bone replacement. Arch Pathol Lab Med 101(1):14–18PubMedGoogle Scholar
  11. 11.
    Fletcher C, Unni K (2002) Pathology and genetics of tumours of soft tissue and bone. IARC Press, LyonGoogle Scholar
  12. 12.
    Saeter G, Bruland O (1998) High-grade osteosarcoma: the scope beyond the classical patient. Towards the Eradication of Osteosarcoma Metastasis-An Odyssey 21-3Google Scholar
  13. 13.
    Kaplan E, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481CrossRefGoogle Scholar
  14. 14.
    Mantel N (1966) Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 50(3):163–170PubMedGoogle Scholar
  15. 15.
    Cox D (1972) Regression models and life tables. J R Stat Soc B 34:187–220Google Scholar
  16. 16.
    Fisher RA (1922) On the interpretation of Χ2 from contingency tables, and the calculation of P. J R Stat Soc 85(1):87–94CrossRefGoogle Scholar
  17. 17.
    Bruland OS, Bauer H, Alvegaard T, Smeland S (2009) Treatment of osteosarcoma. The Scandinavian Sarcoma Group experience. Cancer Treat Res 152:309–318CrossRefPubMedGoogle Scholar
  18. 18.
    Huber GF, Dziegielewski P, Wayne Matthews T, Dort JC (2008) Head and neck osteosarcoma in adults: the province of Alberta experience over 26 years. J Otolaryngol Head Neck Surg 37(5):738–743PubMedGoogle Scholar
  19. 19.
    Sturgis EM, Potter BO (2003) Sarcomas of the head and neck region. Curr Opin Oncol 15(3):239–252CrossRefPubMedGoogle Scholar
  20. 20.
    Guadagnolo BA, Zagars GK, Raymond AK, Benjamin RS, Sturgis EM (2009) Osteosarcoma of the jaw/craniofacial region: outcomes after multimodality treatment. Cancer 115(14):3262–3270CrossRefPubMedGoogle Scholar
  21. 21.
    Kassir RR, Rassekh CH, Kinsella JB, Segas J, Carrau RL, Hokanson JA (1997) Osteosarcoma of the head and neck: meta-analysis of nonrandomized studies. Laryngoscope 107(1):56–61CrossRefPubMedGoogle Scholar
  22. 22.
    Schwarz R, Bruland O, Cassoni A, Schomberg P, Bielack S (2009) The role of radiotherapy in osteosarcoma. Cancer Treat Res 152:147–164CrossRefPubMedGoogle Scholar
  23. 23.
    Kammerer PW, Shabazfar N, Vorkhshori Makoie N, Moergel M, Al-Nawas B (2012) Clinical, therapeutic and prognostic features of osteosarcoma of the jaws—experience of 36 cases. J Craniomaxillofac Surg 40(6):541–548CrossRefPubMedGoogle Scholar
  24. 24.
    Patel SG, Meyers P, Huvos AG, Wolden S, Singh B, Shaha AR et al (2002) Improved outcomes in patients with osteogenic sarcoma of the head and neck. Cancer 95(7):1495–1503CrossRefPubMedGoogle Scholar
  25. 25.
    Konig M, Mork J, Hall KS, Osnes T, Meling TR (2010) Multimodal treatment of osteogenic sarcoma of the jaw. Skull Base 20(3):207–212CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Jasnau S, Meyer U, Potratz J, Jundt G, Kevric M, Joos UK et al (2008) Craniofacial osteosarcoma experience of the cooperative German-Austrian-Swiss osteosarcoma study group. Oral Oncol 44(3):286–294CrossRefPubMedGoogle Scholar
  27. 27.
    Mendenhall WM, Fernandes R, Werning JW, Vaysberg M, Malyapa RS, Mendenhall NP (2011) Head and neck osteosarcoma. Am J Otolaryngol 32(6):597–600CrossRefPubMedGoogle Scholar
  28. 28.
    Ferrari D, Codeca C, Battisti N, Broggio F, Crepaldi F, Violati M et al (2014) Multimodality treatment of osteosarcoma of the jaw: a single institution experience. Med Oncol 31(9):171CrossRefPubMedGoogle Scholar
  29. 29.
    Mark RJ, Sercarz JA, Tran L, Dodd LG, Selch M, Calcaterra TC (1991) Osteogenic sarcoma of the head and neck. The UCLA experience. Arch Otolaryngol Head Neck Surg 117(7):761–766CrossRefPubMedGoogle Scholar
  30. 30.
    Oda D, Bavisotto LM, Schmidt RA, McNutt M, Bruckner JD, Conrad EU 3rd et al (1997) Head and neck osteosarcoma at the University of Washington. Head Neck 19(6):513–523CrossRefPubMedGoogle Scholar
  31. 31.
    Ha PK, Eisele DW, Frassica FJ, Zahurak ML, McCarthy EF (1999) Osteosarcoma of the head and neck: a review of the Johns Hopkins experience. Laryngoscope 109(6):964–969CrossRefPubMedGoogle Scholar
  32. 32.
    Gorsky M, Epstein JB (2000) Craniofacial osseous and chondromatous sarcomas in British Columbia—a review of 34 cases. Oral Oncol 36(1):27–31CrossRefPubMedGoogle Scholar
  33. 33.
    Smith RB, Apostolakis LW, Karnell LH, Koch BB, Robinson RA, Zhen W et al (2003) National Cancer Data Base report on osteosarcoma of the head and neck. Cancer 98(8):1670–1680CrossRefPubMedGoogle Scholar
  34. 34.
    Garrington GE, Scofield HH, Cornyn J, Hooker SP (1967) Osteosarcoma of the jaws. Analysis of 56 cases. Cancer 20(3):377–391CrossRefPubMedGoogle Scholar
  35. 35.
    Roca AN, Smith JL Jr, Jing BS (1970) Osteosarcoma and parosteal osteogenic sarcoma of the maxilla and mandible: study of 20 cases. Am J Clin Pathol 54(4):625–636CrossRefPubMedGoogle Scholar
  36. 36.
    Caron AS, Hajdu SI, Strong EW (1971) Osteogenic sarcoma of the facial and cranial bones. A review of forty-three cases. Am J Surg 122(6):719–725CrossRefPubMedGoogle Scholar
  37. 37.
    Russ JE, Jesse RH (1980) Management of osteosarcoma of the maxilla and mandible. Am J Surg 140(4):572–576CrossRefPubMedGoogle Scholar
  38. 38.
    Nora FE, Unni KK, Pritchard DJ, Dahlin DC (1983) Osteosarcoma of extragnathic craniofacial bones. Mayo Clin Proc 58(4):268–272PubMedGoogle Scholar
  39. 39.
    Clark JL, Unni KK, Dahlin DC, Devine KD (1983) Osteosarcoma of the jaw. Cancer 51(12):2311–2316CrossRefPubMedGoogle Scholar
  40. 40.
    Forteza G, Colmenero B, Lopez-Barea F (1986) Osteogenic sarcoma of the maxilla and mandible. Oral Surg Oral Med Oral Pathol 62(2):179–184CrossRefPubMedGoogle Scholar
  41. 41.
    Bertoni F, Dallera P, Bacchini P, Marchetti C, Campobassi A (1991) The Istituto Rizzoli-Beretta experience with osteosarcoma of the jaw. Cancer 68(7):1555–1563CrossRefPubMedGoogle Scholar
  42. 42.
    Vege DS, Borges AM, Aggrawal K, Balasubramaniam G, Parikh DM, Bhaser B (1991) Osteosarcoma of the craniofacial bones. A clinico-pathological study. J Craniomaxillofac Surg 19(2):90–93CrossRefPubMedGoogle Scholar
  43. 43.
    Wanebo HJ, Koness RJ, MacFarlane JK, Eilber FR, Byers RM, Elias EG et al (1992) Head and neck sarcoma: report of the Head and Neck Sarcoma Registry. Society of Head and Neck Surgeons Committee on Research. Head Neck 14(1):1–7CrossRefPubMedGoogle Scholar
  44. 44.
    Salvati M, Ciappetta P, Raco A (1993) Osteosarcomas of the skull. Clinical remarks on 19 cases. Cancer 71(7):2210–2216CrossRefPubMedGoogle Scholar
  45. 45.
    Delgado R, Maafs E, Alfeiran A, Mohar A, Barrera JL, Zinser J et al (1994) Osteosarcoma of the jaw. Head Neck 16(3):246–252CrossRefPubMedGoogle Scholar
  46. 46.
    Koka V, Vericel R, Lartigau E, Lusinchi A, Schwaab G (1994) Sarcomas of nasal cavity and paranasal sinuses: chondrosarcoma, osteosarcoma and fibrosarcoma. J Laryngol Otol 108(11):947–953CrossRefPubMedGoogle Scholar
  47. 47.
    August M, Magennis P, Dewitt D (1997) Osteogenic sarcoma of the jaws: factors influencing prognosis. Int J Oral Maxillofac Surg 26(3):198–204CrossRefPubMedGoogle Scholar
  48. 48.
    van Es RJ, Keus RB, van der Waal I, Koole R, Vermey A (1997) Osteosarcoma of the jaw bones. Long-term follow up of 48 cases. Int J Oral Maxillofac Surg 26(3):191–197CrossRefPubMedGoogle Scholar
  49. 49.
    Canadian Society of O-H, Neck Surgery Oncology Study G (2004) Osteogenic sarcoma of the mandible and maxilla: a Canadian review (1980-2000). J Otolaryngol 33(3):139–144CrossRefGoogle Scholar
  50. 50.
    Fernandes R, Nikitakis NG, Pazoki A, Ord RA (2007) Osteogenic sarcoma of the jaw: a 10-year experience. J Oral Maxillofac Surg 65(7):1286–1291CrossRefPubMedGoogle Scholar
  51. 51.
    Laskar S, Basu A, Muckaden MA, D’Cruz A, Pai S, Jambhekar N et al (2008) Osteosarcoma of the head and neck region: lessons learned from a single-institution experience of 50 patients. Head Neck 30(8):1020–1026CrossRefPubMedGoogle Scholar
  52. 52.
    Paparella ML, Olvi LG, Brandizzi D, Keszler A, Santini-Araujo E, Cabrini RL (2013) Osteosarcoma of the jaw: an analysis of a series of 74 cases. Histopathology 63(4):551–557PubMedGoogle Scholar
  53. 53.
    Lim S, Lee S, Rha SY, Rho JK (2013) Craniofacial osteosarcoma: single institutional experience in Korea. Asia Pac J Clin OncolGoogle Scholar
  54. 54.
    Smeele LE, Kostense PJ, van der Waal I, Snow GB (1997) Effect of chemotherapy on survival of craniofacial osteosarcoma: a systematic review of 201 patients. J Clin Oncol 15(1):363–367CrossRefPubMedGoogle Scholar
  55. 55.
    Smeele LE, Snow GB, van der Waal I (1998) Osteosarcoma of the head and neck: meta-analysis of the nonrandomized studies. Laryngoscope 108(6):946CrossRefPubMedGoogle Scholar
  56. 56.
    Smeele LE, van der Wal JE, van Diest PJ, van der Waal I, Snow GB (1994) Radical surgical treatment in craniofacial osteosarcoma gives excellent survival. A retrospective cohort study of 14 patients. Eur J Cancer B Oral Oncol 30B(6):374–376CrossRefPubMedGoogle Scholar
  57. 57.
    Akbiyik N, Alexander LL (1981) Osteosarcoma of the maxilla treated with radiation therapy and surgery. J Natl Med Assoc 73(4):355–356PubMedPubMedCentralGoogle Scholar
  58. 58.
    Briant TD, Bird R (1981) Osteogenic sarcoma of the mandible. J Otolaryngol 10(2):149–161PubMedGoogle Scholar
  59. 59.
    deFries HO, Perlin E, Leibel SA (1979) Treatment of osteogenic sarcoma of the mandible. Arch Otolaryngol 105(6):358–359CrossRefPubMedGoogle Scholar
  60. 60.
    Goepfert H, Ballantyne AJ, Matalon V, McCarthy E (1979) Osteogenic sarcoma of the mandible: surgical resection and prosthetic rehabilitation. Otolaryngol Head Neck Surg (1979) 87(4):417–419CrossRefGoogle Scholar
  61. 61.
    Gomez AC, Youmans RD, Chambers RG (1960) Osteogenic sarcoma of the mandible. A method of treatment. Am J Surg 100:613–616CrossRefPubMedGoogle Scholar
  62. 62.
    Hadley C, Gressot LV, Patel AJ, Wang LL, Flores RJ, Whitehead WE et al (2014) Osteosarcoma of the cranial vault and skull base in pediatric patients. J Neurosurg Pediatr 13(4):380–387CrossRefPubMedGoogle Scholar
  63. 63.
    Kragh LV, Dahlin DC, Erich JB (1958) Osteogenic sarcoma of the jaws and facial bones. Am J Surg 96(4):496–505CrossRefPubMedGoogle Scholar
  64. 64.
    LiVolsi VA (1977) Osteogenic sarcoma of the maxilla. Arch Otolaryngol 103(8):485–488CrossRefPubMedGoogle Scholar
  65. 65.
    Mardinger O, Givol N, Talmi YP, Taicher S (2001) Osteosarcoma of the jaw. The Chaim Sheba Medical Center experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 91(4):445–451CrossRefPubMedGoogle Scholar
  66. 66.
    Schwartz DT, Alpert M (1963) The clinical course of mandibular osteogenic sarcoma. Oral Surg Oral Med Oral Pathol 16:769–776CrossRefPubMedGoogle Scholar
  67. 67.
    van den Berg H, Schreuder WH, de Lange J (2013) Osteosarcoma: a comparison of jaw versus nonjaw localizations and review of the literature. Sarcoma 2013:316123PubMedPubMedCentralGoogle Scholar
  68. 68.
    Sundaresan N, Huvos AG, Rosen G, Galicich JH (1985) Combined-modality treatment of osteogenic sarcoma of the skull. J Neurosurg 63(4):562–567CrossRefPubMedGoogle Scholar
  69. 69.
    Huvos AG, Sundaresan N, Bretsky SS, Butler A (1985) Osteogenic sarcoma of the skull. A clinicopathologic study of 19 patients. Cancer 56(5):1214–1221CrossRefPubMedGoogle Scholar
  70. 70.
    Boon E, van der Graaf WT, Gelderblom H, Tesselaar ME, van Es RJ, Oosting SF, et al. (2016) Impact of chemotherapy on the outcome of osteosarcoma of the head and neck in adults. Head NeckGoogle Scholar
  71. 71.
    Carrle D, Bielack SS (2006) Current strategies of chemotherapy in osteosarcoma. Int Orthop 30(6):445–451CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    Isakoff MS, Bielack SS, Meltzer P, Gorlick R (2015) Osteosarcoma: current treatment and a collaborative pathway to success. J Clin Oncol 33(27):3029–3035CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Bielack SS, Wulff B, Delling G, Gobel U, Kotz R, Ritter J et al (1995) Osteosarcoma of the trunk treated by multimodal therapy: experience of the Cooperative Osteosarcoma study group (COSS). Med Pediatr Oncol 24(1):6–12CrossRefPubMedGoogle Scholar
  74. 74.
    Bilsky MH, Bentz B, Vitaz T, Shah J, Kraus D (2005) Craniofacial resection for cranial base malignancies involving the infratemporal fossa. Neurosurgery 57(4 Suppl):339–347 discussion -47PubMedPubMedCentralGoogle Scholar
  75. 75.
    Anninga JK, Gelderblom H, Fiocco M, Kroep JR, Taminiau AH, Hogendoorn PC et al (2011) Chemotherapeutic adjuvant treatment for osteosarcoma: where do we stand? Eur J Cancer 47(16):2431–2445CrossRefPubMedGoogle Scholar
  76. 76.
    Bielack SS, Smeland S, Whelan JS, Marina N, Jovic G, Hook JM et al (2015) Methotrexate, doxorubicin, and cisplatin (MAP) plus maintenance pegylated interferon alfa-2b versus MAP alone in patients with resectable high-grade osteosarcoma and good histologic response to preoperative MAP: first results of the EURAMOS-1 good response randomized controlled trial. J Clin Oncol 33(20):2279–2287CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Ferrari S, Smeland S, Mercuri M, Bertoni F, Longhi A, Ruggieri P et al (2005) Neoadjuvant chemotherapy with high-dose ifosfamide, high-dose methotrexate, cisplatin, and doxorubicin for patients with localized osteosarcoma of the extremity: a joint study by the Italian and Scandinavian Sarcoma Groups. J Clin Oncol 23(34):8845–8852CrossRefPubMedGoogle Scholar
  78. 78.
    Bhandare N, Monroe AT, Morris CG, Bhatti MT, Mendenhall WM (2005) Does altered fractionation influence the risk of radiation-induced optic neuropathy? Int J Radiat Oncol Biol Phys 62(4):1070–1077CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of NeurosurgeryOslo University Hospital - RikshospitaletOsloNorway
  2. 2.Department of NeurologyOstfold Hospital TrustGralumNorway
  3. 3.Institute of Clinical MedicineUniversity of OsloOsloNorway
  4. 4.Department of OtorhinolaryngologyOslo University Hospital - RikshospitaletOsloNorway
  5. 5.Department of PathologyOslo University Hospital - RadiumhospitaletOsloNorway
  6. 6.Department of OncologyOslo University Hospital - RadiumhospitaletOsloNorway

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