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  • 1
    Language: English
    In: Surgical oncology, 2009, Vol.19 (4), p.193-199
    Description: Abstract Background Approximately one-third of patients with localized osteosarcoma at presentation relapse as well as about three-fourths of the patients with metastases at diagnosis, about 90% of relapses are lung metastases. The role of lung metastasectomy remains to be determined. Patients and methods: Three hundred and twenty three patients, 88 with resectable lung metastases at diagnosis and 235 with localized disease at presentation who relapsed with lung metastases were treated. Results A total of 498 lung surgeries and 607 thoracotomies were performed. The 5 year overall survival was 37%. Final outcome was significantly related to presence or absence of metastasis, time of first relapse and presence of local recurrences. According to stage of the disease, the rate of a 5 year event-free survival (EFS) was 36% for patients with localized disease who later relapsed and 9% for patients with resectable lung metastases at presentation ( p 〈 0.0001). However, there were no differences in EFS between patients who underwent two or three thoracotomies and patients who had four or five thoracotomies (7.5 vs 18.7%, p = 0.29). Conclusions In patients with recurrent resectable pulmonary metastases from high grade osteosarcoma treated with adjuvant or neoadjuvant chemotherapy, thoracotomy should always be considered regardless the number of previous lung relapses and the number of secondary pulmonary lesions.
    Subject(s): Hematology, Oncology and Palliative Medicine ; Surgery ; metastases ; Osteosarcoma ; Lung ; Extremities ; Osteosarcoma - drug therapy ; Lung Neoplasms - drug therapy ; Humans ; Middle Aged ; Child, Preschool ; Male ; Thoracotomy ; Bone Neoplasms - pathology ; Young Adult ; Lung Neoplasms - secondary ; Adult ; Female ; Retrospective Studies ; Bone Neoplasms - drug therapy ; Child ; Neoplasm Recurrence, Local ; Treatment Outcome ; Bone Neoplasms - surgery ; Osteosarcoma - surgery ; Adolescent ; Survival Analysis ; Lung Neoplasms - surgery ; Combined Modality Therapy - methods ; Osteosarcoma - secondary ; Care and treatment ; Metastasis ; Index Medicus
    ISSN: 0960-7404
    E-ISSN: 1879-3320
    Source: ProQuest Central
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 2
    Language: English
    In: Journal of clinical oncology, 2012-06-10, Vol.30 (17), p.2112-2118
    Description: We compared two chemotherapy regimens that included methotrexate (MTX), cisplatin (CDP), and doxorubicin (ADM) with or without ifosfamide (IFO) in patients with nonmetastatic osteosarcoma of the extremity. Patients age ≤ 40 years randomly received regimens with the same cumulative doses of drugs (ADM 420 mg/m(2), MTX 120 g/m(2), CDP 600 mg/m(2), and IFO 30 g/m(2)) but with different durations (arm A, 44 weeks; arm B, 34 weeks). IFO was given postoperatively when pathologic response to MTX-CDP-ADM was poor (arm A) or given in the primary phase of chemotherapy with MTX-CDP-ADM (arm B). End points of the study included pathologic response to preoperative chemotherapy, toxicity, and survival. Given the feasibility of accrual, the statistical plan only permitted detection of a 15% difference in 5-year overall survival (OS). From April 2001 to December 2006, 246 patients were enrolled. Two hundred thirty patients (94%) underwent limb salvage surgery (arm A, 92%; arm B, 96%; P = .5). Chemotherapy-induced necrosis was good in 45% of patients (48% in arm A, 42% in arm B; P = .3). Four patients died of treatment-related toxicity (arm A, n = 1; arm B, n = 3). A significantly higher incidence of hematologic toxicity was reported in arm B. With a median follow-up of 66 months (range, 1 to 104 months), 5-year OS and event-free survival (EFS) rates were not significantly different between arm A and arm B, with OS being 73% (95% CI, 65% to 81%) in arm A and 74% (95% CI, 66% to 82%) in arm B and EFS being 64% (95% CI, 56% to 73%) in arm A and 55% (95% CI, 46% to 64%) in arm B. IFO added to MTX, CDP, and ADM from the preoperative phase does not improve the good responder rate and increases hematologic toxicity. IFO should only be considered in patients who have a poor histologic response to MTX, CDP, and ADM.
    Subject(s): Biological and medical sciences ; Medical sciences ; Diseases of the osteoarticular system ; Tumors of striated muscle and skeleton ; Tumors ; Osteosarcoma - drug therapy ; Femur - pathology ; Humans ; Child, Preschool ; Male ; Tibia - pathology ; Cisplatin - administration & dosage ; Humerus - pathology ; Disease-Free Survival ; Ifosfamide - administration & dosage ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Chemotherapy, Adjuvant - methods ; Adolescent ; Adult ; Female ; Methotrexate - administration & dosage ; Bone Neoplasms - drug therapy ; Child ; Doxorubicin - administration & dosage
    ISSN: 0732-183X
    E-ISSN: 1527-7755
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
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  • 3
    Language: English
    In: Journal of clinical oncology, 2005-12-01, Vol.23 (34), p.8845-8852
    Description: To explore the effect of high-dose ifosfamide in first-line treatment for patients 〈 or = 40 years of age with nonmetastatic osteosarcoma of the extremity. From March 1997 to September 2000, 182 patients were evaluated. Primary treatment consisted of two blocks of high-dose ifosfamide (15 g/m2), methotrexate (12 g/m2), cisplatin (120 mg/m2), and doxorubicin (75 mg/m2). Postoperatively, patients received two cycles of doxorubicin (90 mg/m2), and three cycles each of high-dose ifosfamide, methotrexate, and cisplatin (120 to 150 mg/m2). Granulocyte colony-stimulating factor support was mandatory after the high-dose ifosfamide/cisplatin/doxorubicin combination. No disease progression was recorded during primary chemotherapy, 164 patients (92%) underwent limb-salvage surgery, four patients (2%) underwent rotation plasty, and 11 patients (6%) had limbs amputated. Three (1.6%) patients died as a result of treatment-related toxicity, and one died as a result of pulmonary embolism after pathologic fracture. Grade 4 neutropenia and thrombocytopenia followed 52% and 31% of all courses, respectively, and mild to severe nephrotoxicity was recorded in 19 patients (10%). The median received dose-intensity compared with protocol was 0.82. With a median follow-up of 55 months, the 5-year probability of event-free survival was 64% (95% CI, 57% to 71%) and overall survival was 77% (95% CI, 67% to 81%), whereas seven patients (4%) experienced local recurrence. The addition of high-dose ifosfamide to methotrexate, cisplatin, and doxorubicin in the preoperative phase is feasible, but with major renal and hematologic toxicities, and survival rates similar to those obtained with four-drug regimens using standard-dose ifosfamide. Italian Sarcoma Group/Scandinavian Sarcoma Group study I showed that in a multicenter setting, more than 90% of patients with osteosarcoma of the extremity can undergo conservative surgery.
    Subject(s): Biological and medical sciences ; Chemotherapy ; Medical sciences ; Antineoplastic agents ; Pharmacology. Drug treatments ; Tumors ; Prospective Studies ; Bone Neoplasms - therapy ; Follow-Up Studies ; Humans ; Antineoplastic Combined Chemotherapy Protocols - adverse effects ; Child, Preschool ; Male ; Bone Neoplasms - pathology ; Cisplatin - administration & dosage ; Dose-Response Relationship, Drug ; Renal Insufficiency - chemically induced ; Adult ; Female ; Child ; Extremities ; Doxorubicin - administration & dosage ; Ifosfamide - adverse effects ; Neoplasm Recurrence, Local ; Treatment Outcome ; Scandinavian and Nordic Countries ; Disease-Free Survival ; Methotrexate - adverse effects ; Ifosfamide - administration & dosage ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Adolescent ; Cisplatin - adverse effects ; Italy ; Methotrexate - administration & dosage ; Patient Compliance ; Osteosarcoma - therapy ; Doxorubicin - adverse effects ; Heart Failure - chemically induced ; Osteosarcoma - pathology ; Clinical Medicine ; Medical and Health Sciences ; Klinisk medicin ; Cancer and Oncology ; Medicin och hälsovetenskap ; Cancer och onkologi
    ISSN: 0732-183X
    ISSN: 1527-7755
    E-ISSN: 1527-7755
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
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  • 4
    Language: English
    In: Journal of clinical oncology, 2003-02-15, Vol.21 (4), p.710-715
    Description: To identify factors that influence postrelapse survival (PRS) in patients with nonmetastatic osteosarcoma of the extremity. One hundred sixty-two patients with recurrent osteosarcoma of the extremity were retrospectively reviewed. The first-line treatment included surgery of the primary lesion and chemotherapy with methotrexate, doxorubicin, cisplatin, and ifosfamide. The projected 5-year PRS rate was 28%. Patients who had complete surgery of recurrence had a 5-year PRS of 39%, whereas for those who did not have complete surgery, PRS was 0% at 3 years (P 〈.0001). In the latter group, PRS was not influenced by site of recurrence and relapse-free interval (RFI), although it was influenced (P =.006) by the use of second-line chemotherapy (PRS, 53% at 12 months for patients who received chemotherapy v 12% for those who did not). In patients who had complete surgery, PRS was influenced by site of relapse (5-year PRS, lung 44%, other 19%; P 〈.06), RFI (5-year PRS at 〈 or = 24 months, 20%; at 〉 24 months, 60%; P 〈.0001), and number of lung metastases (5-year PRS, two or fewer nodules, 59%; more than two nodules, 14%; P 〈.0001) but not by the use of a second-line chemotherapy treatment. RFI, site of metastases, and number of pulmonary nodules are the main prognostic factors for PRS in osteosarcoma. Complete surgery of recurrence is pivotal in the strategy of treatment. Patients with unresectable recurrence benefit from second-line chemotherapy, whereas our data do not support a generalized use of chemotherapy after complete surgery of first recurrence.
    Subject(s): Biological and medical sciences ; Medical sciences ; Diseases of the osteoarticular system ; Tumors of striated muscle and skeleton ; Osteosarcoma - drug therapy ; Bone Neoplasms - mortality ; Confidence Intervals ; Osteosarcoma - mortality ; Prognosis ; Lung Neoplasms - mortality ; Humans ; Middle Aged ; Neoplasm Recurrence, Local ; Child, Preschool ; Antineoplastic Agents - therapeutic use ; Bone Neoplasms - pathology ; Lung Neoplasms - secondary ; Adolescent ; Adult ; Lung Neoplasms - surgery ; Retrospective Studies ; Bone Neoplasms - drug therapy ; Child ; Osteosarcoma - pathology ; Index Medicus
    ISSN: 0732-183X
    E-ISSN: 1527-7755
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 5
    Language: English
    In: Journal of clinical oncology, 2000-12-15, Vol.18 (24), p.4016-4027
    Description: To provide an estimate of long-term prognosis for patients with osteosarcoma of the extremity treated in a single institution with neoadjuvant chemotherapy and observed for at least 10 years. Patients with nonmetastatic osteosarcoma of the extremity were preoperatively treated with high-dose methotrexate, cisplatin, and doxorubicin (ADM). Postoperatively, good responders (90% or more tumor necrosis) received the same three drugs used before surgery, whereas poor responders (less than 90% tumor necrosis) received ifosfamide and etoposide in addition to those three drugs. For the 164 patients who entered the study between September 1986 and December 1989, surgery was a limb salvage in 136 cases (82%) and a good histologic response was observed in 117 patients (71%). At a follow-up ranging from 10 to 13 years (median, 11.5 years), 101 patients (61%) remained continuously free of disease, 61 relapsed, and two died of ADM-induced cardiotoxicity. There were no differences in prognosis between good and poor responding patients. ADM-induced cardiotoxicity (six patients), male infertility (10 of the 12 assessable patients), and second malignancies (seven patients) were the major complications of chemotherapy. Despite the large number of limb salvages performed, only four local recurrences (2.4%) were registered. With an aggressive neoadjuvant chemotherapy, it is possible to cure more than 60% of patients with nonmetastatic osteosarcoma of the extremity and amputation may be avoided in more than 80% of them. Because local or systemic relapses, myocardiopathies, and second malignancies are possible even 5 years or more after the beginning of treatment, a long-term follow-up is recommended for these patients.
    Subject(s): Biological and medical sciences ; Chemotherapy ; Medical sciences ; Antineoplastic agents ; Pharmacology. Drug treatments ; Osteosarcoma - drug therapy ; Postoperative Complications - etiology ; Follow-Up Studies ; Humans ; Male ; Neoplasms, Second Primary - surgery ; Neoplasm Recurrence, Local - surgery ; Cisplatin - administration & dosage ; Fertility - drug effects ; Adult ; Female ; Neoadjuvant Therapy ; Bone Neoplasms - drug therapy ; Child ; Extremities ; Osteosarcoma - diagnostic imaging ; Doxorubicin - administration & dosage ; Reoperation ; Bone Neoplasms - diagnostic imaging ; Postoperative Complications - surgery ; Etoposide - administration & dosage ; Survival Rate ; Neoplasm Recurrence, Local - diagnosis ; Bone Neoplasms - surgery ; Neoplasms, Second Primary - etiology ; Radiography ; Disease-Free Survival ; Ifosfamide - administration & dosage ; Osteosarcoma - surgery ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Adolescent ; Methotrexate - administration & dosage ; Patient Compliance ; Neoplasms, Second Primary - drug therapy ; Reconstructive Surgical Procedures ; Index Medicus
    ISSN: 0732-183X
    E-ISSN: 1527-7755
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 6
    Language: English
    In: Journal of clinical oncology, 2000-01-01, Vol.18 (1), p.4-11
    Description: The identification of prognostic factors in patients with nonmetastatic Ewing's sarcoma could allow the use of risk-adapted therapeutic strategies of treatment. Data on 359 patients with nonmetastatic Ewing's sarcoma of bone treated at a single institution between January 1979 and April 1995 were retrospectively considered. The influence of clinical, hematologic, therapeutic, and histologic parameters on event-free survival was assessed. By univariate analysis, the following features were found to be associated with a poor prognosis: male sex (P 〈.02), age older than 12 years (P 〈.006), fever (P 〈.0001), anemia (P 〈.0025), high serum lactate dehydrogenase (LDH) level (P 〈.0001), axial location (P 〈.04), radiation therapy only for local control (P 〈.009), type of chemotherapy regimen (P 〈.0001), and poor chemotherapy-induced necrosis (P 〈.001). After multivariate analysis, the adverse independent prognostic factors were male sex (P 〈.04), age older than 12 years (P 〈.001), fever (P 〈.0002), anemia (P 〈.02), high serum LDH level (P 〈.0003), axial location (P 〈.02), and type of chemotherapy regimen (P 〈.0003). When the multivariate analysis was restricted to surgically treated patients, the adverse independent prognostic factors were poor chemotherapy-induced necrosis (P 〈.0001), fever (P 〈.015), anemia (P 〈.02), and high serum LDH level (P 〈.025). The prognosis in cases of nonmetastatic Ewing's sarcoma is influenced by many different clinical and hematologic variables, all of which are to be considered when patients are being stratified according to the risk of relapse. In surgically treated patients, the most important prognostic factor is chemotherapy-induced necrosis.
    Subject(s): Biological and medical sciences ; Medical sciences ; Diseases of the osteoarticular system ; Tumors of striated muscle and skeleton ; Bone Neoplasms - mortality ; Cyclophosphamide - administration & dosage ; Prognosis ; Humans ; Male ; Sarcoma, Ewing - mortality ; Vincristine - administration & dosage ; Adult ; Female ; Retrospective Studies ; Bone Neoplasms - drug therapy ; Child ; Doxorubicin - administration & dosage ; Bone Neoplasms - diagnosis ; Neoplasm Recurrence, Local ; Proportional Hazards Models ; Etoposide - administration & dosage ; Sarcoma, Ewing - diagnosis ; Dactinomycin - administration & dosage ; Sarcoma, Ewing - drug therapy ; Biomarkers, Tumor - blood ; Disease-Free Survival ; Analysis of Variance ; Ifosfamide - administration & dosage ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Chemotherapy, Adjuvant - methods ; L-Lactate Dehydrogenase - blood ; Adolescent ; Italy - epidemiology
    ISSN: 0732-183X
    E-ISSN: 1527-7755
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
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  • 7
    Language: English
    In: European spine journal, 2009-08, Vol.18 (8), p.1091-1095
    Description: The objective of this study is to determine the best local treatment combined with neoadjuvant chemotherapy for ESFT of the spine and sacrum, for the best local treatment for Ewing sarcoma family tumors (ESFT) according to the primary site is still unclear. Nowadays surgery is used in local treatment of ESFT, but literature is scarce on the best local treatment in sites where surgery is problematic, such as the spine. This study evaluates the outcome and the rate of local recurrence of ESFT in the spine and sacrum when treated with neoadjuvant chemotherapy, and locally by radiotherapy alone or surgery, followed by reduced doses of radiotherapy. Forty-three patients with nonmetastatic ESFT located in the spine and sacrum were treated at our institution between 1983 and 2000 with neoadjuvant chemotherapy, and locally by radiotherapy alone in 26 cases, and surgery followed by radiotherapy at reduced doses in 17. The 5- and 10-year event-free survival (EFS) was 37 and 30%, and the 5- and 10-year overall survival was (OS) 42 and 32%. The prognosis was unrelated to gender and age, tumor volume, chemotherapy protocol, and local treatment. The outcome seemed worse for patients with primary tumors located in the sacrum than for patients with tumors located in the rest of the spine (5-year EFS = 23 vs. 46%). For these patients the results were significantly worse than for those we achieved with neoadjuvant treatment for ESFT located in other sites. However, no differences were observed between patients locally treated with radiotherapy alone and those treated by radiotherapy followed by surgery. We concluded that regardless of the type of local treatment even when associated with neoadjuvant therapy, ESFT in the spine and sacrum has a poor outcome and prognosis is significantly worse than that of primary ESFT in other sites.
    Subject(s): Humans ; Neoplasm Recurrence, Local ; Male ; Combined Modality Therapy ; Spinal Neoplasms - drug therapy ; Sarcoma, Ewing - drug therapy ; Young Adult ; Disease-Free Survival ; Sacrum ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Adolescent ; Adult ; Female ; Retrospective Studies ; Chemotherapy, Adjuvant ; Sarcoma, Ewing - radiotherapy ; Spinal Neoplasms - radiotherapy ; Spinal Neoplasms - surgery ; Sarcoma, Ewing - surgery ; Care and treatment ; Chemotherapy ; Radiotherapy ; Ewing's sarcoma ; Cancer ; Index Medicus ; Neoadjuvant chemotherapy ; Ewing’s sarcoma family tumors ; Original ; Surgery ; Spine and sacrum
    ISSN: 0940-6719
    E-ISSN: 1432-0932
    Source: PubMed Central
    Source: Alma/SFX Local Collection
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 8
    Language: English
    In: Journal of clinical oncology, 2003-02-01, Vol.21 (3), p.536-542
    Description: To evaluate the prognostic value of P-glycoprotein and clinicopathologic parameters in a large series of high-grade osteosarcoma (OS) patients treated at the Rizzoli Institute. With the use of immunohistochemistry, P-glycoprotein was assessed in 149 patients with primary, nonmetastatic, high-grade OS who were homogeneously treated with chemotherapy protocols based on doxorubicin, high-dose methotrexate, and cisplatin and the addition of ifosfamide in the postoperative phase. P-glycoprotein positivity was found in 47 of 149 cases (32%) and was significantly associated with a higher incidence of relapse and a worse outcome, as was age younger than 12 years and tumor volume greater then 150 mL at diagnosis. Multivariate analysis further confirmed the prognostic value of these parameters, which all were independent adverse prognostic factors. Event-free survival and proportional hazards regression analyses confirmed that overexpression of P-glycoprotein at clinical onset is the most important adverse prognostic factor for high-grade OS patients treated with these chemotherapy protocols. Increased P-glycoprotein levels, together with tumor volume and age, should be taken into consideration to identify, at time of diagnosis, subgroups of OS patients with a higher risk of recurrence. This subgroup identification will constitute the basis for drawing individualized treatment protocols on the basis of risk evaluation, with the aim of using more aggressive chemotherapy, or combination chemotherapy with other adjuvants, only in those patients for which more aggressive regimens are strictly necessary and warranted.
    Subject(s): Chemotherapy ; Pharmacology. Drug treatments ; Diseases of the osteoarticular system ; Tumors of striated muscle and skeleton ; Biological and medical sciences ; Medical sciences ; Antineoplastic agents ; Immunohistochemistry ; Osteosarcoma - drug therapy ; Prognosis ; Age Factors ; Humans ; Male ; Bone Neoplasms - pathology ; Cisplatin - administration & dosage ; Female ; Bone Neoplasms - drug therapy ; Chemotherapy, Adjuvant ; Child ; Doxorubicin - administration & dosage ; Biomarkers, Tumor - analysis ; Risk Factors ; Neoplasm Recurrence, Local ; Bone Neoplasms - surgery ; ATP-Binding Cassette, Sub-Family B, Member 1 - analysis ; Ifosfamide - administration & dosage ; Leg - pathology ; Osteosarcoma - surgery ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Adolescent ; Methotrexate - administration & dosage ; Neoplasm Staging ; Arm - pathology ; Osteosarcoma - pathology ; Index Medicus
    ISSN: 0732-183X
    E-ISSN: 1527-7755
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 9
    Language: English
    In: The New England journal of medicine, 1995-11-23, Vol.333 (21), p.1380-1385
    Description: The resistance of tumors to multiple drugs is a major problem in cancer chemotherapy. P-glycoprotein, a transmembrane ATP-dependent efflux pump encoded by the mdr1 gene, 1 has a central role in multidrug resistance in vitro, 2 and its clinical relevance is under investigation. 3 , 4 Increased amounts of P-glycoprotein may confer multidrug resistance on cells by preventing the intracellular accumulation of a variety of cytotoxic drugs, 5 including doxorubicin, the most effective agent for the treatment of osteosarcomas. Drug resistance may represent an important prognostic factor in osteosarcoma, the most frequent primary malignant bone tumor. Although the outcome of osteosarcoma has improved considerably since . . .
    Subject(s): Biological and medical sciences ; Medical sciences ; Diseases of the osteoarticular system ; Tumors of striated muscle and skeleton ; Immunohistochemistry ; Osteosarcoma - drug therapy ; Prognosis ; Humans ; Proportional Hazards Models ; Male ; Combined Modality Therapy ; Osteosarcoma - chemistry ; Bone Neoplasms - surgery ; Bone Neoplasms - pathology ; Necrosis ; Disease-Free Survival ; ATP-Binding Cassette, Sub-Family B, Member 1 - analysis ; Osteosarcoma - surgery ; Adolescent ; Bone Neoplasms - chemistry ; Adult ; Female ; Bone Neoplasms - drug therapy ; Extremities ; Osteosarcoma - pathology ; Physiological aspects ; Glycoproteins ; Osteosarcoma ; Chemotherapy ; Bone cancer ; Biopsy ; Surgery ; Tumors ; Index Medicus ; Abridged Index Medicus
    ISSN: 0028-4793
    E-ISSN: 1533-4406
    Source: Single Journals
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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  • 10
    Language: English
    In: Cancer, 2006, Vol.106 (5), p.1154-1161
    Description: The evaluation variables influencing systemic and local recurrence and final outcome are extremely important in defining risk-adapted treatments for patients with nonmetastatic osteosarcoma of the extremity. A homogeneous group of 789 patients treated at a single institution between March 1983 and March 1999 with different protocols of neoadjuvant chemotherapy, with a minimum followup of 5 years, were retrospectively evaluated in relation to gender, age, serum levels of alkaline phosphatase, tumor site and size of the pathologic fracture, type of surgery, protocol of chemotherapy, surgical margins, and histologic response to preoperative treatment. The 5-year event-free survival (EFS) and overall survival rates were 60.1% and 67.5%, respectively. Upon univariate analysis, EFS was significantly related to the age of patients, serum value of alkaline phosphatase, tumor volume, histologic subtype, type of surgery, surgical margins, histologic response to preoperative treatment, and chemotherapy protocol. Local recurrences (4.8%) were significantly correlated with surgical margins. The 5-year post-recurrence EFS survival was 17% and was significantly lower for patients who had a local recurrence and metastases than for those with metastases only. Patients who had a recurrence only in the lung had a post-recurrence survival rate significantly better than others, correlated with the number of metastatic nodules and the length of the disease-free interval. Upon multivariate analysis, age 〈 or = 14 years, high serum levels of alkaline phosphatase, tumor volume 〉 200 mL, a two-drug regimen chemotherapy, inadequate surgical margins, and poor histologic response to treatment maintained independent prognostic values on the outcome of nonmetastatic osteosarcoma of the extremities. These factors must be considered when deciding risk-adapted treatments for osteosarcoma patients.
    Subject(s): Biological and medical sciences ; Medical sciences ; Diseases of the osteoarticular system ; Tumors of striated muscle and skeleton ; Tumors ; Osteosarcoma - drug therapy ; Prognosis ; Age Factors ; Humans ; Neoplasm Recurrence, Local ; Child, Preschool ; Fractures, Bone ; Male ; Bone Neoplasms - surgery ; Bone Neoplasms - pathology ; Biomarkers, Tumor - blood ; Disease-Free Survival ; Osteosarcoma - surgery ; Adolescent ; Sex Factors ; Adult ; Female ; Neoadjuvant Therapy ; Retrospective Studies ; Bone Neoplasms - drug therapy ; Child ; Osteosarcoma - pathology ; Cancer patients ; Osteosarcoma ; Patient outcomes ; Adjuvant treatment ; Limb salvage ; Cancer ; Index Medicus ; Abridged Index Medicus
    ISSN: 0008-543X
    E-ISSN: 1097-0142
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
    Source: © ProQuest LLC All rights reserved〈img src="https://exlibris-pub.s3.amazonaws.com/PQ_Logo.jpg" style="vertical-align:middle;margin-left:7px"〉
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