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Clinical and Translational Oncology

, Volume 18, Issue 9, pp 937–944 | Cite as

Prognosticating metastatic osteosarcoma treated with uniform chemotherapy protocol without high dose methotrexate and delayed metastasectomy: a single center experience of 102 patients

  • V. Nataraj
  • S. Rastogi
  • S. A. Khan
  • M. C. Sharma
  • S. Agarwala
  • S. Vishnubhatla
  • S. BakhshiEmail author
Research Article

Abstract

Purpose

Data on prognostic factors in patients with metastatic osteosarcoma treated with uniform chemotherapy protocol are lacking. The objective of this study was to analyze demographic data, treatment outcome and prognostic factors for patients with metastatic osteosarcoma at our center treated with a uniform chemotherapy protocol without high dose methotrexate.

Methods

This is a single-institutional data review of patients treated between June 2003 and December 2012 with neoadjuvant chemotherapy, local site surgery followed by adjuvant chemotherapy and metastasectomy at completion of adjuvant chemotherapy.

Results

102 patients of metastatic osteosarcoma were treated with a median age of 18 years (range 8–48 years), male to female ratio of 3.3:1 and median symptom duration of 4 months. EFS and OS at 5 years were 12.7 ± 0.1 and 28.1 ± 0.1 %, respectively. On multivariate analysis, elevated serum alkaline phosphatase (p < 0.001) and number of metastasis >3 (p = 0.04) were predictive of lower EFS, whereas elevated serum alkaline phosphatase (p = 0.01), number of metastasis >3 (p = 0.05), and margin positivity (p < 0.001) were predictive of lower OS.

Conclusions

This is the largest data on metastatic osteosarcoma treated with a uniform chemotherapy protocol without high dose methotrexate. The data showed prognostic factors similar to what have been observed previously such as elevated serum alkaline phosphatase and >3 metastatic lesions in lung predicting inferior outcome. Notably our survival was comparable to data from other studies despite our practice of delaying metastasectomy to completion of chemotherapy rather than performing the same along with local site surgery.

Keywords

Delayed metastasectomy Metastatic osteosarcoma Without high dose methotrexate 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals/ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Not applicable.

Supplementary material

12094_2015_1467_MOESM1_ESM.tif (98 kb)
Flow diagram depicting treatment schema (TIFF 98 kb)
12094_2015_1467_MOESM2_ESM.doc (75 kb)
Supplementary material 2 (DOCX 75 kb)

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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2015

Authors and Affiliations

  • V. Nataraj
    • 1
  • S. Rastogi
    • 2
  • S. A. Khan
    • 2
  • M. C. Sharma
    • 3
  • S. Agarwala
    • 4
  • S. Vishnubhatla
    • 5
  • S. Bakhshi
    • 1
    Email author
  1. 1.Department of Medical OncologyDr. B.R.A Institute Rotary Cancer Hospital, All India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of OrthopedicsAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.Department of PathologyAll India Institute of Medical SciencesNew DelhiIndia
  4. 4.Department of Pediatric SurgeryAll India Institute of Medical SciencesNew DelhiIndia
  5. 5.Department of BiostatisticsAll India Institute of Medical SciencesNew DelhiIndia

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