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Primary Osteosarcoma in the Elderly Revisited: Current Concepts in Diagnosis and Treatment

  • Sarcomas (SR Patel, Section Editor)
  • Published:
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Abstract

Purpose of Review

Osteosarcoma is mostly seen in bones of children and young adults. When it occurs in older persons, the tumor is considered secondary usually complicating Paget disease or irradiated bone. However, there is a second incidence peak of primary osteosarcoma later in life when these tumors occur de novo. This article describes the clinical, imaging, and treatment of POS in older patients, including demographic data of patients from our institution.

Findings

We present our experience with 920 cases of osteosarcoma that were seen between 1984 and 2003 at the University of Texas MD Anderson Cancer Center in Houston, TX, USA. Among the 868 primary osteosarcoma of bones, there were 100 (11.52%), which comprised 69% of the tumors in patients over the age of 50 years. Older patients with primary osteosarcoma tend to have relatively more common axial skeleton involvement, have more distant disease, and are difficult to treat because of concomitant comorbidities. Despite that, most adult patients treated with chemotherapy have shown good results with longer disease-free survival.

Summary

A lytic bone lesion seen in radiographs of elderly patients should include primary osteosarcoma among differential diagnoses. Radical surgery and chemotherapy seem to ensure long-term disease-free survival in most cases. The elderly patients with POS in pelvis, spine, and upper extremities and those with distant disease (metastases) have worse prognosis.

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Acknowledgments

We are thankful to Mr. Wei Wei, Principal Biostatistician at UT MD Anderson Cancer Center, Houston, TX, for his valuable contribution in preparation of this manuscript.

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Author notes

  1. Meena Kumar

    Present address: Department of Diagnostic Imaging, Section of Nuclear Medicine, Veterans Administration Hospital, 1660 S. Columbian Way, Seattle, WA, 98108, USA

  2. Kavin Malhotra

    Present address: Victoria Radiology Associates, 2701 Hospital Drive, Victoria, TX, 77901, USA

Authors and Affiliations

  1. Department of Diagnostic Imaging, UT MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1475, Houston, TX, 77030, USA

    Rajendra Kumar

  2. Victoria Radiology Associates, 2701 Hospital Drive, Victoria, TX, 77901, USA

    Shreyaskumar Patel

  3. Department of Sarcoma Medical Oncology, UT MD Anderson Cancer Center, 1400 – Holcombe Blvd., Unit # 450, Houston, TX, 77030, USA

    Shreyaskumar Patel

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Correspondence to Rajendra Kumar.

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Conflict of Interest

Rajendra Kumar declares that he has no conflict of interest.

Meena Kumar declares that she has no conflict of interest.

Kavin Malhotra declares that he has no conflict of interest.

Shreyaskumar Patel has received research funding through grants from Janssen, Eisai, and Morphotek, and has received compensation from Janssen, Eisai, Morphotek, EMD-Serono, CytRx, Bayer, Eli Lilly, Epizyme, and Novartis for service as a consultant.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Sarcomas

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Kumar, R., Kumar, M., Malhotra, K. et al. Primary Osteosarcoma in the Elderly Revisited: Current Concepts in Diagnosis and Treatment. Curr Oncol Rep 20, 13 (2018). https://doi.org/10.1007/s11912-018-0658-1

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  • DOI: https://doi.org/10.1007/s11912-018-0658-1

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