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PubMed2006

Prognosis of radiation-induced bone sarcoma is similar to primary osteosarcoma.

UNLABELLED: Radiation-induced sarcoma of bone (RISB) is thought to be associated with a poor prognosis. The purpose of this study was to determine disease-free and overall survival of patients treated for RISB, and whether there is a role for limb sparing surgery. Twenty-four patients had a mean latency of 16 years between radiation for their index cancer and RISB diagnosis. The most common tumor was osteosarcoma (n = 17). Ten patients with localized disease treated aggressively with chemotherapy and surgical resection had estimated 5-year disease-free and overall survival rates of 58% and 69% respectively. Patients treated by surgery alone or those with metastases at diagnosis had inferior outcomes. Patients who received a complete course of chemotherapy demonstrated better histologic tumor response and improved survival. There was no difference in survival between the limb sparing surgery (n = 12) or amputation (n = 8) groups. However, limb salvage patients had slightly higher rates of local tumor relapse and post-operative complications. Functional outcome following limb sparing surgery for 10 patients with RISB was similar to a matched cohort treated for primary osteosarcoma. An aggressive treatment approach for patients with RISB may provide similar rates of local recurrence and metastasis and functional outcomes compared to patients with primary osteosarcoma. LEVEL OF EVIDENCE: Therapeutic study, level IV-1.

Adolescent↗
PubMed2003

Marriage and fertility in long-term survivors of high grade osteosarcoma.

One hundred fifteen patients with high grade osteosarcoma were treated at our hospital between 1976 and 1995. Of these, 45 patients still surviving and disease free for more than 5 years since the conclusion of treatment were enrolled as the subjects. The marriage proportion (number of married persons/number of all persons) and fertility proportion (number of persons having an offspring/number of married persons) of these 45 patients were investigated. The marriage proportion of male patients was 20.8% (5/24), whereas that of female patients was 76.2% (16/21). The marriage proportion in male patients was dramatically lower than that in female patients (p = 0.0003). The marriage proportion in male patients was significantly lower than that in brothers of the patients (p = 0.0223). In female patients, the treatment of osteosarcoma had no influence on marriage, whereas in male patients it had a great influence on marriage. The fertility proportion in married patients was 76.2% (16/21) and that in siblings of the patients was 81.0% (17/21). A total of 18 offspring were born to married patients. These offspring had no birth defects or congenital anomalies. The chemotherapy used in the treatment of osteosarcoma had little influence on the fertility of patients or the health of their offspring.

Adult↗
PubMedDate not supplied

Osteosarcoma after external beam radiation therapy for recurrent choroidal melanoma.

A 59-year-old woman underwent enucleation for choroidal melanoma. She had a late recurrence of the melanoma, which was treated with surgery and radiotherapy. Nine years after radiation treatment, she presented with pain and an orbital mass. Biopsy of the mass revealed an osteoblastic osteosarcoma. This report describes the late recurrence of choroidal melanoma and subsequent radiation-induced osteosarcoma. The risk of radiation-induced malignancy should be considered in all patients receiving radiotherapy. Despite yearly review, osteosarcoma was diagnosed only when the patient had symptoms, thus raising questions about the merits of long-term follow-up in detecting recurrence or emergence of secondary tumors.

Choroid Neoplasms↗
PubMed2003

Expression of platelet-derived growth factor-AA is associated with tumor progression in osteosarcoma.

Platelet-derived growth factors are secreted by mesenchymal cells. The homodimer platelet-derived growth factor-AA especially stimulates bone cells through interaction with the platelet-derived growth factor-alpha receptor homodimer. In this study we wanted to determine the expression of the receptor and its ligand in human osteosarcomas and to correlate the expression of platelet-derived growth factor-AA and -alpha receptor with clinicopathological parameters. Fifty-seven osteosarcomas were immunohistochemically analyzed for expression of platelet-derived growth factor-AA and platelet-derived growth factor-alpha receptor. Spearman's correlation coefficient revealed a strong correlation between the expression of platelet-derived growth factor-AA and platelet-derived growth factor-alpha receptor (r = 0.867). No differences were observed relative to gender, age, tumor stage, tumor location, and response to neoadjuvant chemotherapy between high or low platelet-derived growth factor-AA and platelet-derived growth factor-alpha receptor expression. High platelet-derived growth factor-AA expression correlated with tumor progression in univariate analysis (P = .0415; log-rank test), whereas platelet-derived growth factor-alpha receptor expression showed a trend toward a shorter disease-free survival, which failed to reach significance (P = .0627, log-rank test). In multivariate analysis, platelet-derived growth factor-AA expression remained a significant independent predictor of tumor progression (P = .021, Cox regression). Immunohistochemical analysis of platelet-derived growth factor-AA expression in osteosarcoma may be a useful marker of prognosis and may be considered as a possible target for novel therapeutic strategies.

Adolescent↗
PubMed2005

Primary high-grade osteosarcoma: comparison between preadolescent and older patients.

The medical records of patients with high-grade osteosarcoma observed at the authors' institution between 1972 and 1999 were reviewed to study whether osteosarcoma in preadolescent patients has a different biology and a worse prognosis than in older patients. To assess epidemiologic differences, the first analysis evaluated 1,603 patients regardless of tumor stage and site and treatment received. In the second analysis, only 1,136 patients (317 preadolescent and 819 older patients) with nonmetastatic extremity osteosarcoma, treated with the same protocols of chemotherapy, were evaluated to assess differences in prognosis and in the pattern of relapse. Most preadolescents were female (56% vs. 44%, P < 0.0001), and most tumors were located in the extremity (95% vs. 5%, P < 0.001). The 5-year event-free survival (60% [95% CI 53-67%] vs. 58% [95% CI 46-63%]), the overall survival (67% vs. 65%), the rate of amputation (24% vs. 25%), time (21 vs. 22 months) and type of first relapse (systemic 98% vs. 95%, local 2.3% vs. 4.7%) the site of first metastases (pulmonary, 87% vs. 89%), and good histologic response to preoperative treatment (65% vs. 63%) were essentially the same. The authors concluded that there is no need to employ different therapies for the two groups.

Adolescent↗
PubMed2006

Second malignant neoplasm in patients with osteosarcoma of the extremities treated with adjuvant and neoadjuvant chemotherapy.

We evaluated the rate of second malignancies in 1205 patients with osteosarcoma of the extremity treated at our Institution with different protocols of adjuvant and neoadjuvant chemotherapy. Twenty-six patients (2.15%) developed a second malignant neoplasm at a median of 7.6 years (1 to 25 y) after primary osteosarcoma treatment. Of these, 2 developed a third cancer which were not considered in the series. Second neoplasms were leukemia (10), breast (7), lung (2), kidney (2), central nervous system cancer (2), soft tissue (1), parotid (1), and colon (1). The rate of second neoplasms was significantly higher in female patients, and the latent period shorter in hematologic tumors compared with solid tumors. Ten of these 26 patients are disease free at a median of 7.7 years (range 1 to 15 y) after the last treatment. The rate of second malignancies observed in the osteosarcoma group was significantly higher than that observed in the control group of 1160 patients with benign tumors treated in the same period at our Institute (2.2% vs. 0.8%, P<0.009). Our study showed that the risk of second neoplasm within 15 years increased and then leveled off and that although secondary solid tumors could be explained as unrelated cases, leukemias seem to be over represented.

Adolescent↗
PubMed2005

Tl-201 and Tc-99m HMDP scintigraphic findings in extraskeletal osteosarcoma.

Extraskeletal osteosarcoma is an extremely rare high-grade malignant soft tissue tumor, which accounts for approximately 4% of osteosarcomas and less than 1% of all soft tissue sarcomas. There have been reports describing the scintigraphic findings of this tumor, especially with Tl-201. We report a biopsy-proven case of extraskeletal osteosarcoma in which the bone and thallium scans were found to be useful in monitoring chemotherapy response. The Tc-99m HMDP bone scan revealed increased extraskeletal uptake in the tumor.

Bone Neoplasms↗
PubMed2005

Osteoblastic osteosarcoma of the mandible: findings on Tc-99m HMDP bone and Ga-67 citrate scintigraphy.

A 25-year-old woman presented with a disturbance in the opening of her mouth 5 months before admission. On admission, painful swelling of the right preauricular region was revealed. Computed tomography (CT) demonstrated a soft tissue density mass around the right condylar process of the mandible. Tc-99m hydroxymethylene diphosphonate (HMDP) bone scintigraphy and Ga-67 citrate scintigraphy showed avid uptake in the mass. The tumor was histologically identified as an osteoblastic osteosarcoma of the right mandible. There are few reports of Ga-67 citrate scintigraphy findings of osteoblastic osteosarcoma of the mandible. The accumulation patterns on Tc-99m HMDP bone scintigraphy and Ga-67 citrate scintigraphy are possibly characteristic of osteoblastic osteosarcoma of the mandible.

Adult↗
PubMed2007

Clinical outcome of osteosarcoma with primary total femoral resection.

Primary total femoral resection and reconstruction rarely are indicated for patients with osteosarcoma. We determined the survivorship, complications, and functional outcome of patients with osteosarcomas who had total femoral resections. We evaluated 13 patients with osteosarcomas whose surgical conditions included multiple skip lesions along the femur (Group I, two patients), extensive femoral involvement without interruption (Group II, eight patients), and iatrogenic contamination of the femur secondary to an internal fixation (Group III, three patients). We analyzed the event-free survival, complications, and functional outcome and looked for obvious differences among the three groups. The minimum followup was 9 months (mean, 41 months; range, 9-125 months). The Kaplan-Meier event-free survival rate at 10 years was 34.6% (95% confidence interval, 7.5%-61.7%). All five patients in Groups I and III died. Four of eight patients in Group II were event-free survivors. Four patients had major complications. Five patients had good functional scores. The subset of patients who had relatively small tumors with wide resection margins had a good prognosis. In patients with other clinical conditions, hip disarticulation can be considered.

Adolescent↗
PubMed2003

Expression of the coxsackievirus and adenovirus receptor in musculoskeletal tumors and mesenchymal tissues: efficacy of adenoviral gene therapy for osteosarcoma.

Recombinant adenovirus is used as a competent vector in a wide spectrum of cancer gene therapies. Adenovirus infection depends on coxsackievirus and adenovirus receptor (CAR)-mediated virus attachment to the cell surface. However, the expression levels of CAR and the efficiency of adenoviral gene transduction in musculoskeletal tumors have not been systematically investigated. To study the feasibility of gene therapy in musculoskeletal tumors, the expression levels of CAR and the antiproliferative effect of an adenovirally transduced wild-type p53 tumor suppressor gene were examined in 15 distinct musculoskeletal tumor cell lines, 19 tumor tissue samples, and the corresponding pathologically unremarkable mesenchymal tissues. The expression levels of the CAR gene were significantly higher in six of seven osteosarcoma cell lines and two of five osteosarcoma tissue samples than in the other cell lines, musculoskeletal tumors, and mesenchymal tissues. CAR expression levels were closely correlated with adenoviral gene transduction efficiency and the antiproliferative effect of a transduced adenoviral p53 gene in the tested cell lines. In addition, an immunocytochemical study confirmed that transfected green fluorescent protein (GFP) borne by Ad-CAG-GFP was expressed at the cell surface of CAR-positive cells. These results indicate that CAR expression is a critical determinant of transduction efficiency in adenovirus-based gene therapy. Most osteosarcomas appeared to express high levels of CAR, and thus adenovirus-mediated p53 gene therapy is likely to be suitable for the treatment of such tumors.

Adenoviruses, Human↗
PubMed2006

In vitro effects of meloxicam with or without doxorubicin on canine osteosarcoma cells.

Cyclooxygenase (COX) inhibitors, already widely used to reduce fever, inflammation and pain, are under increasing consideration as potential agents for the prevention and treatment of neoplasia. As COX-2 was detected in human and canine osteosarcomas, we have evaluated the effect of the preferential COX-2 inhibitor meloxicam on an established D-17 canine osteosarcoma cell line, which expressed, as well as COX-1 and COX-2 also COX-3 (as demonstrated by Western blot). An XTT proliferation kit was used to assess surviving cells after drug treatment. At low concentrations (1, 2, 4 and 10 microm) meloxicam caused an increase in cell numbers while a marked anti-proliferative effect was observed at higher concentrations (100, 200 microm) after 3 days and also 3 weeks of incubation. The chemotherapeutic drug doxorubicin showed a cytotoxic effect at all concentrations (60-1920 nm). Exposure of tumour cells to combinations of meloxicam and doxorubicin revealed synergistic effects (with 240 nm doxorubicin), as well as sub-additive and antagonistic results, especially if combined with concentrations of meloxicam typically found in serum. Care should be taken in concluding, on the basis of one in vitro study, that meloxicam does not have a role in the treatment of canine osteosarcomas given that the results from in vivo studies may differ.

Animals↗
PubMed1992

Multifocal osteosarcoma with extensive pleural metastatic disease.

An eighteen year old female presented with multifocal synchronous osteosarcoma, with multiple skeletal foci of tumour in long bones, pelvis and spine. The radiographically dominant lesion was in the right ilium, and this was considered to be the primary site. There was an extensive osseous pleural plaque and there were also metastases to lungs, peritoneum, abdominal wall, adrenal gland and lymph nodes. A review of the literature reveals that multifocal osteosarcoma is an uncommon condition and is probably due to metastatic disease and not multiple primary lesions. Pleural metastatic disease in osteosarcoma has been seldom reported.

Adolescent↗
PubMed1988

High-grade surface osteosarcoma of the left ilium. A case report and review of the literature.

A rare case of high-grade surface osteosarcoma of the left ilium is reported. Trephine biopsy performed on a 31-year-old woman suffering from a huge tumor of the left buttock revealed high-grade osteosarcoma, and hemipelvectomy was undertaken. The surgical specimen showed that the tumor was present on the surface of the left ilium. Ten months after the operation, the patient died of brain metastasis. From these results, we considered this case to be one of high-grade surface osteosarcoma.

Adult↗
PubMed1991

Primary osteosarcoma of the ovary. A case report.

A case of primary osteosarcoma arising in the left ovary of a 75-year-old female is described. The chief complaint was a sensation of lower abdominal mass. An abdominal plain film showed a large calcified mass in pelvic region, and a preoperative diagnosis of "ovarian fibroma" was made. The excised tumor was divided into 4 pieces, resembling an oyster shell. Microscopically, the tumor fragments were composed of compact bone or woven bone with surrounding atypical osteoblasts and osteoclasts. The tumor was partly composed of numerous spindle cells with malignant osteoid or atypical chondroid formation, and diagnosed as "osteosarcoma". The cystic part of the lesion was lined with a single layer of columnar cells, but the tumor contained no other germ elements or stem cells, or malignant epithelium. Therefore, it is doubtful that this tumor originated from teratoma or malignant mixed mesodermal tumor, and we conclude that this ovarian osteosarcoma arose through a neoplastic change in ovarian stromal cells. The patient died 4 months after surgery due to intra-abdominal and intrathoracic dissemination of the tumor.

Aged↗
PubMed1992

Osteosarcoma: then and now. A fifty year review at Royal Prince Alfred Hospital.

The purpose of this study is to review survival, treatment methods and criteria for diagnosis of osteosarcoma at Royal Prince Alfred Hospital during two periods in the last 50 years. The records of 22 patients diagnosed with osteosarcoma and nine with osteosarcoma in Paget's disease (from 1939 to 1950) were reviewed. All but one had died within three years. One patient survived six years. The second series was taken from 1983 to 1990. Forty-nine patients, including three with Paget's sarcoma, were studied. Probability of survival was estimated by actuarial analysis using Kaplan-Meier curves. Overall survival was estimated at 45%. Those patients who were free of metastatic disease at the conclusion of their treatment were estimated to have a probability of survival of 85%.

Adolescent↗
PubMed1995

Video-assisted thoracoscopic wedge resections of pulmonary metastatic osteosarcoma: should it be performed?

We studied the use of video-assisted thoracoscopic (VAT) surgery in the management of metastatic osteosarcoma. From September 1993 to March 1994, we performed a total of 11 VAT wedge resections of pulmonary metastatic osteosarcoma in seven patients (six males, one female, age 12 to 46 years). Three patients had bilateral procedures performed either under the same anaesthesia or in stages. One patient had two operations on the same side. The average number of nodules excised was three. Two patients subsequently required formal lobectomies when the metastatic tumours were either too big or too close to the hilum for safe wedge resections. There was one death on postoperative day 3 due to dysrhythmia. One patient died 5 months later from a progression of his underlying disease. Two patients remained disease free up to 8 and 12 months, respectively, from their first operations. The average postoperative chest drain duration was 1.4 +/- 0.7 days and hospital stay 2.3 +/- 1.1 days. The procedure was well tolerated and postoperative morbidity was minimal. We conclude that although VAT wedge resection of pulmonary metastatic osteosarcoma is feasible technically and is associated with a short hospital stay and minimal morbidity, this approach cannot be recommended when complete resection of all metastases is the goal as the technique relies heavily on computed tomographic scans to detect nodules. Recurrence of metastasis from 4 to 6 months in three of seven patients argues against VAT surgery being an adequate procedure. The high cost of the staplers, in addition, is a secondary consideration.

Adolescent↗
PubMed1998

Rotationplasty of the lower limb for childhood osteosarcoma of the femur.

BACKGROUND: Surgical management of osteosarcoma of the limb in childhood often involves extensive surgery. Intervention ranges from local resection to amputation depending on the level and the extent of the disease process. However, where the disease is extensive the level of amputation may preclude effective prosthetic use. In these circumstances resection of the diseased segment of the limb, i.e. an intercalary amputation and reconstruction with rotation of the tibial component of the limb can provide function equivalent to a below-knee amputee. METHODS: To examine the role of rotationplasty of the lower limb for childhood osteosarcoma of the femur, a retrospective study was carried out which examined the function of five patients who had been treated by a tibial rotationplasty. The records of two patients who had died from metastatic disease 2 and 4 years after surgery were examined. The three surviving patients were examined clinically and their clinical records and radiographs were reviewed. RESULTS: Of the two patients who died from metastatic disease, neither had local recurrence of the tumour, neurovascular complications, late derotations or psychological problems. In the three patients who survived, there had been no local recurrence of tumour or other complication and each has an excellent level of activity with below-knee function using a rotationplasty prosthesis. CONCLUSIONS: For children with osteosarcoma of the femur and with extensive disease that precludes complete limb preservation, resection and tibial rotationplasty provides function far superior to a high above-knee amputation or a hip disarticulation without the risk of local recurrence.

Artificial Limbs↗
PubMedDate not supplied

A case report of primary osteosarcoma of the ovary.

Primary osteosarcoma is one of the rare tumors affecting ovaries. This case is being reported for its rarity, along with a review of the literature. In this study, the patient, a 43-year-old woman, presented with an abdominopelvic mass. Exploratory laparotomy was performed, which revealed an extensive left ovarian mass infiltrating the uterus, small bowel, and urinary bladder. Subtotal hysterectomy and small bowel resection followed by end-to-end anastomosis and bilateral salpingo-ophorectomy were performed. Histopathology showed primary osteosarcoma of the ovary. Eighteen days after surgery, she started presenting with progressive abdominal distention and ultimately developed subacute intestinal obstruction. She was started on carboplatin and epirubicin combination but failed to respond and died of fast progressive disease. It is concluded that primary osteosarcoma of the ovary is a rare disease with poor prognosis.

Adult↗