Skip to main content
Top
Published in: International Orthopaedics 7/2019

01-07-2019 | osteosarcoma | Original Paper

Survival analysis of elderly patients with osteosarcoma

Authors: Yoshinori Imura, Satoshi Takenaka, Shigeki Kakunaga, Takaaki Nakai, Toru Wakamatsu, Hidetatsu Outani, Takaaki Tanaka, Hironari Tamiya, Kazuya Oshima, Kenichiro Hamada, Norifumi Naka, Nobuhito Araki, Ikuo Kudawara, Takafumi Ueda, Hideki Yoshikawa

Published in: International Orthopaedics | Issue 7/2019

Login to get access

Abstract

Background

Few studies have described the characteristics and prognostic factors of elderly patients with osteosarcoma. We retrospectively investigated clinico-pathological features and prognostic factors in osteosarcoma patients > 40 years old.

Methods

Patients with high-grade osteosarcoma > 40 years old who were treated at our institutions from 2000 to 2016 were recruited for this study. Information on patient, tumour, and treatment-related factors was collected and statistically analyzed. The median follow-up was 26.5 months (range, 5–139 months) for all patients.

Results

Fifty patients (30 males and 20 females) were included. The median age at diagnosis was 59.5 years (range, 41–81 years). The primary lesions were found in the limbs in 32 patients, trunk in 12, and craniofacial bones in six. Primary and secondary osteosarcoma occurred in 41 and 9 patients, respectively. Eight patients exhibited initial distant metastasis. Definitive surgery and chemotherapy were performed in 39 patients each. The rate of good responders after neoadjuvant chemotherapy was 38%. The five year overall survival (OS) rates for all patients and those without distant metastasis at diagnosis were 44.5% and 51.1%, respectively. Multivariate analysis showed that definitive surgery was the only significant prognostic factor in non-metastatic patients. The five year OS and disease-free survival (DFS) rates for non-metastatic patients who received definitive surgery were 64.3% and 60%, respectively. Among these patients, neoadjuvant and/or adjuvant chemotherapy significantly improved both OS and DFS.

Conclusions

Complete surgical resection and intensive chemotherapy should be performed for osteosarcoma patients > 40 years old despite distinct clinicopathological characteristics from those of younger patients.
Literature
1.
go back to reference Mirabello L, Troisi RJ, Savage SA (2009) Osteosarcoma incidence and survival rates from 1973 to 2004: data from the Surveillance, Epidemiology, and End Results Program. Cancer 115:1531–1543CrossRefPubMed Mirabello L, Troisi RJ, Savage SA (2009) Osteosarcoma incidence and survival rates from 1973 to 2004: data from the Surveillance, Epidemiology, and End Results Program. Cancer 115:1531–1543CrossRefPubMed
2.
go back to reference Bacci G, Picci P, Ferrari S et al (1993) Primary chemotherapy and delayed surgery for nonmetastatic osteosarcoma of the extremities. Results in 164 patients preoperatively treated with high doses of methotrexate followed by cisplatin and doxorubicin. Cancer 72:3227–3238CrossRefPubMed Bacci G, Picci P, Ferrari S et al (1993) Primary chemotherapy and delayed surgery for nonmetastatic osteosarcoma of the extremities. Results in 164 patients preoperatively treated with high doses of methotrexate followed by cisplatin and doxorubicin. Cancer 72:3227–3238CrossRefPubMed
3.
go back to reference Bacci G, Longhi A, Fagioli F et al (2005) Adjuvant and neoadjuvant chemotherapy for osteosarcoma of the extremities: 27 year experience at Rizzoli Institute, Italy. Eur J Cancer 41:2836–2845CrossRefPubMed Bacci G, Longhi A, Fagioli F et al (2005) Adjuvant and neoadjuvant chemotherapy for osteosarcoma of the extremities: 27 year experience at Rizzoli Institute, Italy. Eur J Cancer 41:2836–2845CrossRefPubMed
4.
go back to reference Ferrari S, Smeland S, Mercuri M 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 23:8845–8852CrossRefPubMed Ferrari S, Smeland S, Mercuri M 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 23:8845–8852CrossRefPubMed
5.
go back to reference Carsi B, Rock MG (2002) Primary osteosarcoma in adults older than 40 years. Clin Orthop Relat Res 397:53–61 Carsi B, Rock MG (2002) Primary osteosarcoma in adults older than 40 years. Clin Orthop Relat Res 397:53–61
6.
go back to reference Grimer RJ, Cannon SR, Taminiau AM et al (2003) Osteosarcoma over the age of forty. Eur J Cancer 39:157–163CrossRefPubMed Grimer RJ, Cannon SR, Taminiau AM et al (2003) Osteosarcoma over the age of forty. Eur J Cancer 39:157–163CrossRefPubMed
7.
go back to reference Okada K, Hasegawa T, Nishida J et al (2004) Osteosarcomas after the age of 50: a clinicopathologic study of 64 cases—an experience in northern Japan. Ann Surg Oncol 11:998–1004CrossRefPubMed Okada K, Hasegawa T, Nishida J et al (2004) Osteosarcomas after the age of 50: a clinicopathologic study of 64 cases—an experience in northern Japan. Ann Surg Oncol 11:998–1004CrossRefPubMed
8.
go back to reference Manoso MW, Healey JH, Boland PJ et al (2005) De novo osteogenic sarcoma in patients older than forty: benefit of multimodality therapy. Clin Orthop Relat Res 438:110–115CrossRefPubMed Manoso MW, Healey JH, Boland PJ et al (2005) De novo osteogenic sarcoma in patients older than forty: benefit of multimodality therapy. Clin Orthop Relat Res 438:110–115CrossRefPubMed
9.
go back to reference Jeon DG, Lee SY, Cho WH et al (2006) Primary osteosarcoma in patients older than 40 years of age. J Korean MedSci 21:715–718CrossRef Jeon DG, Lee SY, Cho WH et al (2006) Primary osteosarcoma in patients older than 40 years of age. J Korean MedSci 21:715–718CrossRef
10.
go back to reference Longhi A, Errani C, Gonzales-Arabio D et al (2008) Osteosarcoma in patients older than 65 years. J Clin Oncol 26:5368–5373CrossRefPubMed Longhi A, Errani C, Gonzales-Arabio D et al (2008) Osteosarcoma in patients older than 65 years. J Clin Oncol 26:5368–5373CrossRefPubMed
11.
go back to reference Nishida Y, Isu K, Ueda T et al (2009) Osteosarcoma in the elderly over 60 years: a multicenter study by the Japanese Musculoskeletal Oncology Group. J Surg Oncol 100:48–54CrossRefPubMed Nishida Y, Isu K, Ueda T et al (2009) Osteosarcoma in the elderly over 60 years: a multicenter study by the Japanese Musculoskeletal Oncology Group. J Surg Oncol 100:48–54CrossRefPubMed
12.
go back to reference Iwata S, Ishii T, Kawai A et al (2014) Prognostic factors in elderly osteosarcoma patients: a multi-institutional retrospective study of 86 cases. Ann Surg Oncol 21:263–268CrossRefPubMed Iwata S, Ishii T, Kawai A et al (2014) Prognostic factors in elderly osteosarcoma patients: a multi-institutional retrospective study of 86 cases. Ann Surg Oncol 21:263–268CrossRefPubMed
13.
go back to reference Joo MW, Shin SH, Kang YK et al (2015) Osteosarcoma in Asian populations over the age of 40 years: a multicenter study. Ann Surg Oncol 22:3557–3564CrossRefPubMed Joo MW, Shin SH, Kang YK et al (2015) Osteosarcoma in Asian populations over the age of 40 years: a multicenter study. Ann Surg Oncol 22:3557–3564CrossRefPubMed
14.
go back to reference Bacci G, Ferrari S, Donati D et al (1998) Neoadjuvant chemotherapy for osteosarcoma of the extremity in patients in the fourth and fifth decade of life. Oncol Rep 5:1259–1263PubMed Bacci G, Ferrari S, Donati D et al (1998) Neoadjuvant chemotherapy for osteosarcoma of the extremity in patients in the fourth and fifth decade of life. Oncol Rep 5:1259–1263PubMed
15.
go back to reference Bacci G, Ferrari S, Mercuri M et al (2007) Neoadjuvant chemotherapy for osteosarcoma of the extremities in patients aged 41-60 years: outcome in 34 cases treated with adriamycin, cisplatinum and ifosfamide between 1984 and 1999. Acta Orthop 78:377–384CrossRefPubMed Bacci G, Ferrari S, Mercuri M et al (2007) Neoadjuvant chemotherapy for osteosarcoma of the extremities in patients aged 41-60 years: outcome in 34 cases treated with adriamycin, cisplatinum and ifosfamide between 1984 and 1999. Acta Orthop 78:377–384CrossRefPubMed
16.
go back to reference Bielack SS, Kempf-Bielack B, Delling G et al (2002) Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol 20:776–790CrossRefPubMed Bielack SS, Kempf-Bielack B, Delling G et al (2002) Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol 20:776–790CrossRefPubMed
17.
go back to reference Meyers PA, Schwartz CL, Krailo M et al (2005) Osteosarcoma: a randomized, prospective trial of the addition of ifosfamide and/or muramyl tripeptide to cisplatin, doxorubicin, and high-dose methotrexate. J Clin Oncol 23:2004–2011CrossRefPubMed Meyers PA, Schwartz CL, Krailo M et al (2005) Osteosarcoma: a randomized, prospective trial of the addition of ifosfamide and/or muramyl tripeptide to cisplatin, doxorubicin, and high-dose methotrexate. J Clin Oncol 23:2004–2011CrossRefPubMed
18.
go back to reference Stark A, Kreicbergs A, Nilsonne ULF et al (1990) The age of osteosarcoma is increasing. JBJS (Br) 72-B:89–93 Stark A, Kreicbergs A, Nilsonne ULF et al (1990) The age of osteosarcoma is increasing. JBJS (Br) 72-B:89–93
19.
go back to reference Ferrari S, Ruggieri P, Cefalo G et al (2012) Neoadjuvant chemotherapy with methotrexate, cisplatin, and doxorubicin with or without ifosfamide in nonmetastatic osteosarcoma of the extremity: an Italian sarcoma group trial ISG/OS-1. J Clin Oncol 30:2112–2118CrossRefPubMed Ferrari S, Ruggieri P, Cefalo G et al (2012) Neoadjuvant chemotherapy with methotrexate, cisplatin, and doxorubicin with or without ifosfamide in nonmetastatic osteosarcoma of the extremity: an Italian sarcoma group trial ISG/OS-1. J Clin Oncol 30:2112–2118CrossRefPubMed
20.
go back to reference Bielack SS, Smeland S, Whelan JS, EURAMOS-1 investigators 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 33:2279–2287CrossRefPubMedPubMedCentral Bielack SS, Smeland S, Whelan JS, EURAMOS-1 investigators 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 33:2279–2287CrossRefPubMedPubMedCentral
21.
go back to reference Marina NM, Smeland S, Bielack SS et al (2016) Comparison of MAPIE versus MAP in patients with a poor response to preoperative chemotherapy for newly diagnosed high-grade osteosarcoma (EURAMOS-1): an open-label, international, randomised controlled trial. Lancet Oncol 17:1396–1408CrossRefPubMedPubMedCentral Marina NM, Smeland S, Bielack SS et al (2016) Comparison of MAPIE versus MAP in patients with a poor response to preoperative chemotherapy for newly diagnosed high-grade osteosarcoma (EURAMOS-1): an open-label, international, randomised controlled trial. Lancet Oncol 17:1396–1408CrossRefPubMedPubMedCentral
22.
go back to reference Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 153:106–120 Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 153:106–120
23.
go back to reference 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 PatholLab Med 101:14–18 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 PatholLab Med 101:14–18
24.
go back to reference Bielack SS, Wulff B, Delling G et al (1995) Osteosarcoma of the trunk treated by multimodal therapy: experience of the Cooperative Osteosarcoma Study Group (COSS). Med Pediatr Oncol 24:6–12CrossRefPubMed Bielack SS, Wulff B, Delling G et al (1995) Osteosarcoma of the trunk treated by multimodal therapy: experience of the Cooperative Osteosarcoma Study Group (COSS). Med Pediatr Oncol 24:6–12CrossRefPubMed
25.
go back to reference Matsunobu A, Imai R, Kamada T et al (2012) Impact of carbon ion radiotherapy for unresectable osteosarcoma of the trunk. Cancer 118:4555–4563CrossRefPubMed Matsunobu A, Imai R, Kamada T et al (2012) Impact of carbon ion radiotherapy for unresectable osteosarcoma of the trunk. Cancer 118:4555–4563CrossRefPubMed
26.
go back to reference Brouwer CAJ, Gietema JA, van den Berg MP et al (2006) Long-term cardiac follow-up in survivors of a malignant bone tumor. Ann Oncol 17:1586–1591CrossRefPubMed Brouwer CAJ, Gietema JA, van den Berg MP et al (2006) Long-term cardiac follow-up in survivors of a malignant bone tumor. Ann Oncol 17:1586–1591CrossRefPubMed
27.
go back to reference Kudawara I, Aoki Y, Ueda T et al (2013) Neoadjuvant and adjuvant chemotherapy with high-dose ifosfamide, doxorubicin, cisplatin and high-dose methotrexate in non-metastatic osteosarcoma of the extremities: a phase II trial in Japan. J Chemother 25:41–48CrossRefPubMed Kudawara I, Aoki Y, Ueda T et al (2013) Neoadjuvant and adjuvant chemotherapy with high-dose ifosfamide, doxorubicin, cisplatin and high-dose methotrexate in non-metastatic osteosarcoma of the extremities: a phase II trial in Japan. J Chemother 25:41–48CrossRefPubMed
Metadata
Title
Survival analysis of elderly patients with osteosarcoma
Authors
Yoshinori Imura
Satoshi Takenaka
Shigeki Kakunaga
Takaaki Nakai
Toru Wakamatsu
Hidetatsu Outani
Takaaki Tanaka
Hironari Tamiya
Kazuya Oshima
Kenichiro Hamada
Norifumi Naka
Nobuhito Araki
Ikuo Kudawara
Takafumi Ueda
Hideki Yoshikawa
Publication date
01-07-2019
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 7/2019
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-019-04332-y

Other articles of this Issue 7/2019

International Orthopaedics 7/2019 Go to the issue