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Connective Tissue Oncology Society |
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| 2001 CTOS Annual Meeting Posters— Surgery LONG
TERM FOLLOW-UP OF STAGE IIB EXTREMITY OSTEOSARCOMA: THE EFFECT OF
LOCAL TUMOR EXTENT ON PROGNOSIS OBJECTIVE: More recent treatment of osteogenic sarcoma (OGS) has improved early survival, yet few protocols utilizing surgery and chemotherapy (chemo) have follow-ups (fu) approaching 20 yrs. We wished to test the hypotheses that: 1) relapses and treatment-related deaths occurred 10 years after initial treatment, decreasing survival; 2) the amount of initial local tumor extension remained a prognostic factor; and 3) the initial size of the tumor remained a prognostic factor; all with a fu approaching 20 yrs. METHODS: In 1999 we re-examined the data of 71 pts with high grade OGS who were treated at the University of Florida from Jan 1, 1979 to Aug 1, 1984. All 71 had surgery, 69 had chemo, and 64 had radiation (59 whole lung, 5 local). 62 of 71 had extremity lesions. Evaluation included 59 pts with conventional, Stage IIB OGS of the extremities: 51 followed Protocol (Prot) (surgery, 5 courses of postoperative Adriamycin (total dose of 450 mg/m2), and 1600 centigray of whole-lung irradiation); 8 did not. Limb salvage surgery was performed in 31% and amputation in 69% of the Prot pts. Tumor extension was graded E1 to E6 for protocol pts, and the maximum tumor dimension was recorded. Tumor extension was E1-E5 (only touching periosteum-invading one structure) in 26 pts and E6 (invading two or more structures) in 25 pts [ref 1]. The probability of overall survival, according to the Kaplan-Meier (K-M) method, was plotted for: all pts (n=71); all chemo pts (n=69); extemity pts (n=62); all extemity IIB pts (n=59); Prot pts (n=51); Prot E1-E5 pts (n=26); Prot E6 pts (n=25); non-extremity pts (n=9); and Prot violators (n=8). K-M curves were compared using a log-rank test, and survival relative to tumor size was evaluated with a t-test. [ref 1. Spanier, S.S.; Shuster, J.J.; and Vander Griend, R.A.: The effect of local extent of the tumor on prognosis in osteosarcoma. J.Bone Joint Surg., 72-A:643-653, 1990.] RESULTS: Average fu was 17.4 yrs for survivors. Survival at 5, 10, 15, and 20 years was: 66,54,54,52% for all pts (n=71) [Fig 1]; 67,55,55,53% for all chemo pts (n=69); 64,57,57,57% for all extremity pts (n=62); 64,57,57,57% for all extremity IIB pts (n=59); 61,55,55,55% for all Prot pts; 81,73,73,73% for all Prot E1-E5 pts (n=26); 40,36,36,36% for all Prot E6 pts (n=25); and 78,33,33,22 for non-extremity pts (n=9). A statistically significant difference in survival remained between groups Protocol E1-E5 and Protocol E6 (p=0.005) [Fig 2]. Tumor size (av) was 9.4 cm for survivors; 11.6 cm for those dead of disease (p=0.06). CONCLUSION: 1) Few late relapses and treatment related deaths occurred greater than 10 yrs after initial treatment; 2) the initial local tumor extension (E1-E5 vs E6) remained a statistically significant prognostic indicator; while 3) tumor size was only marginally significant with a fu approaching 20 yrs.
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