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Second and subsequent recurrences of osteosarcoma: presentation, treatment, and outcomes of 249 consecutive cooperative osteosarcoma study group patients
Journal of Clinical Oncology, 02/03/09

Bielack SS et al. - In a study to evaluate pt and tumor characteristics, treatment, and outcomes in a large cohort of unselected pts with second and subsequent recurrences of osteosarcoma, these results confirm the overwhelming importance of surgical clearance. Prognostic indicators after rerecurrences resemble those known from first recurrence. The exact role of re-treatment with chemotherapy, particularly in the adjuvant situation, remains to be defined.

Methods

249 consecutive pts who had originally received combined-modality therapy on neoadjuvant Cooperative Osteosarcoma Study Group protocols and went on to develop 409 second and subsequent osteosarcoma recurrences were analyzed for patient-, tumor-, and treatment-related factors and outcomes.

Results

5-year overall (OS) and event-free survival (EFS) rates were 16% and 9% for 249 second, 14% and 0% for 93 third, 13% and 6% for 38 fourth, and 18% and 0% for 14 fifth recurrences, respectively.
Proportion of recurrences confined to the lungs decreased and proportion of those with chest wall involvement increased with increasing numbers of recurrences.
Duration of relapse-free intervals and number of lesions at recurrence correlated with outcomes.
While only 1 of 205 pts with rerecurrence survived past 5 yrs without surgical remission, 5-yr OS and EFS rates were 32% and 18% for 119 second, 26% and 0% for 45 third, 28% and 13% for 20 fourth, and 53% and 0% for 5 fifth recurrences, respectively, in which a renewed surgical remission was achieved.
Use of chemotherapy correlated with longer survival in pts without surgical remissions.

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