1
|
Zarghooni K, Bratke G, Landgraf P, Simon T, Maintz D, Eysel P. The Diagnosis and Treatment of Osteosarcoma and Ewing's Sarcoma in Children and Adolescents. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:405-412. [PMID: 37097079 PMCID: PMC10437036 DOI: 10.3238/arztebl.m2023.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 06/24/2022] [Accepted: 03/22/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Osteosarcoma and Ewing's sarcoma in children and adolescents require age-specific interdisciplinary diagnosis and treatment to achieve optimal therapeutic outcomes. METHODS The diagnosis and treatment of malignant bone tumors in childhood and adolescence are presented in the light of publications retrieved by a selective search, pertinent guidelines, and the authors' extensive experience in an interdisciplinary cancer center. RESULTS Bone sarcomas make up approximately 5% of all malignancies in children and adolescents; the most common types are Ewing's sarcoma and osteosarcoma. Patients are often not referred to a specialized center until long after the onset of symptoms, as they and their physicians rarely consider the possibility of a bone tumor, and the symptoms are often trivialized. Bone pain of unknown origin, swelling, and functional limitations should be investigated with conventional x-rays. Lesions of unclear origin should be biopsied after a meticulous clinical and radiologic evaluation. Multimodal treatment consists of neo - adjuvant chemotherapy, limb-preserving resection if possible, and radiotherapy where indicated. In multicenter studies, patients with osteosarcoma achieve event-free survival in 64% of cases if their disease is localized, and 28% if it is metastatic; the corresponding figures for patients with Ewing's sarcoma are 80% and 27%, respectively. CONCLUSION With implementation of the current treatment recommendations, most children and adolescents with malignant bone tumors can be treated successfully with curative intent. These patients should be referred to a sarcoma center for diagnosis and treatment.
Collapse
Affiliation(s)
- Kourosh Zarghooni
- Department of Orthopedics and Trauma Surgery, Helios Hospital Hildesheim, Germany
- Department of Orthopedics and Trauma Surgery, University Hospital Cologne, Germany
| | - Grischa Bratke
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany
| | - Pablo Landgraf
- Department of Pediatric Oncology, University Hospital Cologne, Germany
| | - Thorsten Simon
- Department of Pediatric Oncology, University Hospital Cologne, Germany
| | - David Maintz
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, University Hospital Cologne, Germany
| |
Collapse
|
2
|
Pozza F, Kenne Pagui EC, Salvan A. Improved and computationally stable estimation of relative risk regression with one binary exposure. Stat Methods Med Res 2023; 32:1234-1246. [PMID: 37032617 DOI: 10.1177/09622802231167436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
In medical statistics, when the effect of a binary risk factor on a binary response is of interest, relative risk is often the preferred measure due to its direct interpretation. However, statistical inference on this quantity is not as straightforward as for other measures of association, especially when further explanatory variables have to be taken into account. Starting from a review of available methods for inference on relative risk, this paper deals with small and moderate sample size settings for which we show that classical approaches can be problematic. For this reason, we propose the use of improved estimation procedures, aiming at mean or median bias reduction of the maximum likelihood estimator. In particular, these methods are developed for a new alternative specification of a model recently proposed by Richardson et al, where higher computational stability of the estimation methods is achieved. A real-data example and extensive simulation studies show that the proposed methods perform remarkably better than the standard ones.
Collapse
Affiliation(s)
- Francesco Pozza
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Euloge Clovis Kenne Pagui
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Alessandra Salvan
- Department of Statistical Sciences, University of Padova, Padova, Italy
| |
Collapse
|
3
|
Gersey ZC, Zenonos GA, Gardner PA. Malignant Brain and Spinal Tumors Originating from Bone or Cartilage. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:477-506. [PMID: 37452950 DOI: 10.1007/978-3-031-23705-8_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Malignant bone tumors affecting the brain and spine are a rare and exceedingly difficult-to-treat group of diseases. Most commonly consisting of chordoma and chondrosarcoma, these tumors also include giant-cell tumors and osteosarcomas. This chapter will cover the background, epidemiology, genetics, molecular biology, histopathology, radiographic features, clinical manifestations, therapeutic approaches, and clinical management of each entity.
Collapse
Affiliation(s)
- Zachary C Gersey
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Georgios A Zenonos
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Paul A Gardner
- UPMC Center for Cranial Base Surgery, 200 Lothrop Street, PUH B-400, Pittsburgh, PA, 15213, USA.
| |
Collapse
|
4
|
Abstract
PURPOSE OF REVIEW Osteosarcoma (OSA) is the most common primary tumor of bone, mainly affecting children and adolescents. Here we discuss recent advances in surgical and systemic therapies, and highlight potentially new modalities in preclinical evaluation and prognostication. RECENT FINDINGS The advent of neoadjuvant and adjuvant chemotherapy has markedly improved the disease-free recurrence and overall survival of OSA. However, treatment efficacy has been stagnant since the 1980s. This plateau has prompted preclinical and clinical research into in precision surgery, inhaled chemotherapy to increase pulmonary drug concentration without systemic side effects, and novel immunomodulators intended to block molecular pathways associated with OSA proliferation and metastasis. With the advent of novel surgical techniques and new forms and vectors for chemotherapy, it is hoped that OSA treatment outcomes will exceed their currently sustained plateau in the near future.
Collapse
Affiliation(s)
- Rebekah Belayneh
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mitchell S Fourman
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sumail Bhogal
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kurt R Weiss
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| |
Collapse
|
5
|
Gusho CA, Miller I, Clayton B, Colman MW, Gitelis S, Blank AT. The prognostic significance of lymphovascular tumor invasion in localized high-grade osteosarcoma: Outcomes of a single institution over 10 years. J Surg Oncol 2021; 123:1624-1632. [PMID: 33621357 DOI: 10.1002/jso.26445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUNDS AND OBJECTIVES Lymphovascular invasion (LVI) has shown evidence of an association with worse survival in high-grade osteosarcoma patients. The purpose of this investigation was to prognosticate LVI as a predictor of survival. METHODS This was a retrospective review of high-grade, localized osteosarcoma patients over a consecutive 10-year period. Proportional hazards regression was used to identify prognostic factors. Cumulative mortality incidence was estimated with recurrence as a competing risk. RESULTS Forty-two cases with a median follow-up of 64 months (range, 6-158 months) were reviewed. LVI was present in 21.4% (n = 9) cases. The five- and ten-year survivals in LVI (+) were 40% and 20%, compared to 93% and 81% in LVI (-), respectively (p < .001). After controlling for confounders, advanced age (hazards ratio [HR], 1.134; 95% confidence interval [CI], 1-1.2; p = .01) and LVI (HR, 21.768; 95% CI, 3-135; p = .001) were negative prognosticators. The cumulative incidence of recurrence was no different between LVI (+) and LVI (-) (p = .811), though the incidence of mortality was significantly higher in LVI (+) (p = .003). CONCLUSION The presence of LVI in the setting of high-grade, localized osteosarcoma is associated with greater rates of mortality and appears to portend a dismal prognosis.
Collapse
Affiliation(s)
- Charles A Gusho
- Division of Orthopedic Oncology, Department of Orthopedic Surgery, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Ira Miller
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Bishir Clayton
- Division of Orthopedic Oncology, Department of Orthopedic Surgery, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Matthew W Colman
- Division of Orthopedic Oncology, Department of Orthopedic Surgery, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Steven Gitelis
- Division of Orthopedic Oncology, Department of Orthopedic Surgery, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Alan T Blank
- Division of Orthopedic Oncology, Department of Orthopedic Surgery, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
6
|
Transcriptional activators YAP/TAZ and AXL orchestrate dedifferentiation, cell fate, and metastasis in human osteosarcoma. Cancer Gene Ther 2021; 28:1325-1338. [PMID: 33408328 PMCID: PMC8636268 DOI: 10.1038/s41417-020-00281-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/19/2020] [Accepted: 12/03/2020] [Indexed: 12/12/2022]
Abstract
Osteosarcoma (OS) is a molecularly heterogeneous, aggressive, poorly differentiated pediatric bone cancer that frequently spreads to the lung. Relatively little is known about phenotypic and epigenetic changes that promote lung metastases. To identify key drivers of metastasis, we studied human CCH-OS-D OS cells within a previously described rat acellular lung (ACL) model that preserves the native lung architecture, extracellular matrix, and capillary network. This system identified a subset of cells—termed derived circulating tumor cells (dCTCs)—that can migrate, intravasate, and spread within a bioreactor-perfused capillary network. Remarkably, dCTCs highly expressed epithelial-to-mesenchymal transition (EMT)-associated transcription factors (EMT-TFs), such as ZEB1, TWIST, and SOX9, which suggests that they undergo cellular reprogramming toward a less differentiated state by coopting the same epigenetic machinery used by carcinomas. Since YAP/TAZ and AXL tightly regulate the fate and plasticity of normal mesenchymal cells in response to microenvironmental cues, we explored whether these proteins contributed to OS metastatic potential using an isogenic pair of human OS cell lines that differ in AXL expression. We show that AXL inhibition significantly reduced the number of MG63.2 pulmonary metastases in murine models. Collectively, we present a laboratory-based method to detect and characterize a pure population of dCTCs, which provides a unique opportunity to study how OS cell fate and differentiation contributes to metastatic potential. Though the important step of clinical validation remains, our identification of AXL, ZEB1, and TWIST upregulation raises the tantalizing prospect that EMT-TF-directed therapies might expand the arsenal of therapies used to combat advanced-stage OS.
Collapse
|
7
|
Lilienthal I, Herold N. Targeting Molecular Mechanisms Underlying Treatment Efficacy and Resistance in Osteosarcoma: A Review of Current and Future Strategies. Int J Mol Sci 2020; 21:ijms21186885. [PMID: 32961800 PMCID: PMC7555161 DOI: 10.3390/ijms21186885] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 12/12/2022] Open
Abstract
Osteosarcoma is the most common primary malignant bone tumour in children and adolescents. Due to micrometastatic spread, radical surgery alone rarely results in cure. Introduction of combination chemotherapy in the 1970s, however, dramatically increased overall survival rates from 20% to approximately 70%. Unfortunately, large clinical trials aiming to intensify treatment in the past decades have failed to achieve higher cure rates. In this review, we revisit how the heterogenous nature of osteosarcoma as well as acquired and intrinsic resistance to chemotherapy can account for stagnation in therapy improvement. We summarise current osteosarcoma treatment strategies focusing on molecular determinants of treatment susceptibility and resistance. Understanding therapy susceptibility and resistance provides a basis for rational therapy betterment for both identifying patients that might be cured with less toxic interventions and targeting resistance mechanisms to sensitise resistant osteosarcoma to conventional therapies.
Collapse
Affiliation(s)
- Ingrid Lilienthal
- Division of Paediatric Oncology, Department of Women’s and Children’s Health, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Correspondence: (I.L.); (N.H.); Tel.: +46-(0)8-52483204 (I.L. & N.H.)
| | - Nikolas Herold
- Division of Paediatric Oncology, Department of Women’s and Children’s Health, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Paediatric Oncology, Astrid Lindgren’s Children Hospital, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
- Correspondence: (I.L.); (N.H.); Tel.: +46-(0)8-52483204 (I.L. & N.H.)
| |
Collapse
|
8
|
Pediatric Osteosarcoma of Extremities: A 15-year Experience From a Tertiary Care Cancer Center in Upper Egypt. J Pediatr Hematol Oncol 2019; 41:e371-e383. [PMID: 30629005 DOI: 10.1097/mph.0000000000001407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIM To assess the outcome and determine predictors of survival in pediatric patients with osteosarcoma of the extremities treated with a unified chemotherapy protocol at a single institution over a 15-year period. MATERIALS AND METHODS We performed a retrospective analysis of medical records of 48 pediatric patients with histologically verified osteosarcoma of the extremities diagnosed at South Egypt Cancer Institute and received treatment between January 2001 and December 2015. RESULTS With a median follow-up of 61 months for the entire cohort, estimates of overall survival (OS) for 3- and 5-year were 50.9% and 42.1%, respectively. While the estimates of OS for 3- and 5-year in the nonmetastatic group were 79% and 65.2%, respectively. In the multivariable analysis, both metastatic disease at diagnosis and poor response to chemotherapy retained their statistical significance as independent predictors for event-free survival. Whereas for OS, a metastatic disease at diagnosis remained as the lone predictor of a dismal outcome, while a poor response to chemotherapy became marginally associated with an inferior outcome. CONCLUSIONS In Upper Egypt, whereas slightly less than two thirds of children with localized osteosarcoma of extremities survives their disease, metastasis at presentation remains the key predictor of dismal survival outcomes.
Collapse
|
9
|
Yao H, Wang B, Wen L, Jin Q, Li H, Huang G, Yin J, Zou C, Xie X, Shen J. Comparison of clinical features, management and outcomes of osteosarcoma located in proximal fibula and proximal tibia: a propensity score matching analysis. BMC Cancer 2018; 18:1195. [PMID: 30497436 PMCID: PMC6267921 DOI: 10.1186/s12885-018-5062-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/07/2018] [Indexed: 01/20/2023] Open
Abstract
Background The aim of this study was to compare proximal fibular and proximal tibial sites regarding osteosarcoma in the proximal crus. Furthermore, we proposed a hypothesis explaining the differences. Methods From Jaunary 2000 to February 2015, 28 patients with non-metastatic proximal fibular osteosarcoma and 214 patients with non-metastatic proximal tibial osteosarcoma underwent surgery were identified in our center. All clinical data were analyzed retrospectively. Propensity score matching of patients in a 1:2 ratio was conducted based on age, gender and Enneking stage. To analyze possible factors resulting in amputation, we investigated extraosseous tumor volumes (ETVS), the nearest of the blood vessel to reactive zone (NBR) and the nearest of the blood vessel to tumor (NBT). Results Amputation rates were higher in the proximal fibula cohort (35.7%) than in the proximal tibia cohort (14.3%; p = 0.046). Comparing possible clinical characteristics related with amputation between two cohorts, the proximal fibula cohort had larger ETVS (p = 0.000). Moreover, the proximal fibula cohort had a smaller NBT for anterior tibial vessels (p = 0.025), a smaller NBR for posterior tibial vessels (p = 0.013) and a smaller NBT for posterior tibial vessels (p = 0.007) than the proximal tibia cohort. Univarite and multivariable analyses showed that NBT for posterior tibial vessels was the only independent factor associated with amputation. The 3-year event-free survival (EFS) and overall survival (OS) rates for the proximal fibula cohort vs. the proximal tibia cohort were 52.6% vs. 78.0% (p = 0.045) and 63.7% vs. 81.2% (p = 0.177), respectively. The MSTS scores for the functional evaluation of limb-salvaging surgery were similar in both groups (p = 0.212). Conclusions Amputation rates among patients were higher when osteosarcoma was located in proximal fibula than in proximal tibia. A smaller NBT for posterior tibial vessels was associated with higher amputation rates. Prognosis of the proximal fibula cohort was poorer than that of the proximal tibia cohort of osteosarcoma patients. Electronic supplementary material The online version of this article (10.1186/s12885-018-5062-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Hao Yao
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, 510080, China
| | - Bo Wang
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, 510080, China
| | - Lili Wen
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, 651 Dongfengdong Rd, Guangzhou, 510060, China
| | - Qinglin Jin
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, 510080, China
| | - Hongbo Li
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, 510080, China
| | - Gang Huang
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, 510080, China
| | - Junqiang Yin
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, 510080, China
| | - Changye Zou
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, 510080, China
| | - Xianbiao Xie
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, 510080, China.
| | - Jingnan Shen
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, 510080, China.
| |
Collapse
|
10
|
Crompton JG, Ogura K, Bernthal NM, Kawai A, Eilber FC. Local Control of Soft Tissue and Bone Sarcomas. J Clin Oncol 2018; 36:111-117. [DOI: 10.1200/jco.2017.75.2717] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Sarcomas of soft tissue and bone are mesenchymal malignancies that can arise in any anatomic location, most commonly the extremity, retroperitoneum, and trunk. Even for lower grade histologic subtypes, local recurrence can cause significant morbidity and even disease-related death. Although surgery remains the cornerstone of local control, perioperative radiation and systemic therapy are often important adjuvants. This review will summarize the current therapeutic approaches for local control of soft tissue and bone sarcomas.
Collapse
Affiliation(s)
- Joseph G. Crompton
- Joseph G. Crompton, Nicholas M. Bernthal, and Fritz C. Eilber, University of California Los Angeles, Los Angeles, CA; and Koichi Ogura and Akira Kawai, National Cancer Center Hospital, Tokyo, Japan
| | - Koichi Ogura
- Joseph G. Crompton, Nicholas M. Bernthal, and Fritz C. Eilber, University of California Los Angeles, Los Angeles, CA; and Koichi Ogura and Akira Kawai, National Cancer Center Hospital, Tokyo, Japan
| | - Nicholas M. Bernthal
- Joseph G. Crompton, Nicholas M. Bernthal, and Fritz C. Eilber, University of California Los Angeles, Los Angeles, CA; and Koichi Ogura and Akira Kawai, National Cancer Center Hospital, Tokyo, Japan
| | - Akira Kawai
- Joseph G. Crompton, Nicholas M. Bernthal, and Fritz C. Eilber, University of California Los Angeles, Los Angeles, CA; and Koichi Ogura and Akira Kawai, National Cancer Center Hospital, Tokyo, Japan
| | - Fritz C. Eilber
- Joseph G. Crompton, Nicholas M. Bernthal, and Fritz C. Eilber, University of California Los Angeles, Los Angeles, CA; and Koichi Ogura and Akira Kawai, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
11
|
Zhang T, Zhang S, Yang F, Wang L, Zhu S, Qiu B, Li S, Deng Z. Efficacy Comparison of Six Chemotherapeutic Combinations for Osteosarcoma and Ewing's Sarcoma Treatment: A Network Meta‐Analysis. J Cell Biochem 2017; 119:250-259. [DOI: 10.1002/jcb.25976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/03/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Tao Zhang
- Department of Orthopedic SurgerySecond Affiliated HospitalChongqing Medical UniversityChongqing 400010China
- Department of Orthopedic SurgeryGuizhou Province Osteological HospitalGuiyang 550002GuizhouChina
| | - Song Zhang
- Department of Orthopedic SurgeryGuizhou Province Osteological HospitalGuiyang 550002GuizhouChina
| | - Feifei Yang
- Department of Orthopedic SurgeryGuizhou Province Osteological HospitalGuiyang 550002GuizhouChina
| | - Lili Wang
- Department of Orthopedic SurgeryGuizhou Province Osteological HospitalGuiyang 550002GuizhouChina
| | - Sigang Zhu
- Department of Orthopedic SurgeryGuizhou Province Osteological HospitalGuiyang 550002GuizhouChina
| | - Bing Qiu
- Department of Orthopedic SurgeryGuizhou Province Osteological HospitalGuiyang 550002GuizhouChina
| | - Shunhua Li
- Department of Orthopedic SurgeryGuizhou Province Osteological HospitalGuiyang 550002GuizhouChina
| | - Zhongliang Deng
- Department of Orthopedic SurgerySecond Affiliated HospitalChongqing Medical UniversityChongqing 400010China
| |
Collapse
|
12
|
Nathenson MJ, Conley AP, Sausville E. Immunotherapy: A New (and Old) Approach to Treatment of Soft Tissue and Bone Sarcomas. Oncologist 2017; 23:71-83. [PMID: 28935774 DOI: 10.1634/theoncologist.2016-0025] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 07/14/2017] [Indexed: 12/11/2022] Open
Abstract
Soft tissue and bone sarcomas are a rare and heterogeneous form of cancer. With standard of care treatment options including surgery, radiation, and chemotherapy, the long-term survival is still low for high-risk soft tissue sarcoma patients. New treatment strategies are needed. Immunotherapy offers a new potential treatment paradigm with great promise. Immunotherapy of soft tissue sarcomas dates back to Dr. Coley's first use of toxins in the late 1800s. A variety of strategies of immunotherapy have been tried in soft tissue and bone sarcomas, including various vaccines and cytokines, with limited success. Results of these early clinical trials with vaccines and cytokines were disappointing, but there are reasons to be optimistic. Recent advances, particularly with the use of adoptive T-cell therapy and immune checkpoint inhibitors, have led to a resurgence of this field for all cancer patients. Clinical trials utilizing adoptive T-cell therapy and immune checkpoint inhibitors in soft tissue and bone sarcomas are under way. This paper reviews the current state of evidence for the use of immunotherapy, as well as current immunotherapy strategies (vaccines, adopative T-cell therapy, and immune checkpoint blockade), in soft tissue and bone sarcomas. By understanding the tumor microenviroment of sarcomas and how it relates to their immunoresponsiveness, better immunotherapy clinical trials can be designed, hopefully with improved outcomes for soft tissue and bone sarcoma patients. IMPLICATIONS FOR PRACTICE Immunotherapy is a promising treatment paradigm that is gaining acceptance for the management of several cancers, including melanoma, renal cell carcinoma, prostate cancer, and lung cancer. There is a long history of immunotherapy in the treatment of soft tissue and bone sarcomas, although with little success. It is important to understand past failures to develop future immunotherapy treatment strategies with an improved possibility of success. This article reviews the history of and current state of immunotherapy research in the treatment of soft tissue and bone sarcomas, with particular regard to vaccine trials, adoptive T-cell therapy, and immune checkpoint blockade.
Collapse
Affiliation(s)
- Michael J Nathenson
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Anthony P Conley
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Edward Sausville
- Department of Medicine and Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
13
|
Telangiectatic osteosarcoma: a review of 87 cases. J Cancer Res Clin Oncol 2016; 142:2197-207. [DOI: 10.1007/s00432-016-2210-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/22/2016] [Indexed: 11/26/2022]
|
14
|
Varshosaz J, Sadeghi aliabadi H, Asheghali F. Chondroitin/doxorubicin nanoparticulate polyelectrolyte complex for targeted delivery to HepG2 cells. IET Nanobiotechnol 2016; 11:164-172. [DOI: 10.1049/iet-nbt.2015.0109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jaleh Varshosaz
- Department of PharmaceuticsSchool of Pharmacy and Novel Drug Delivery Systems Research CentreIsfahan University of Medical SciencesIsfahanIran
| | - Hojjat Sadeghi aliabadi
- Department of BiotechnologyFaculty of PharmacyIsfahan University of Medical SciencesIsfahanIran
| | - Fereshte Asheghali
- Department of PharmaceuticsSchool of Pharmacy and Novel Drug Delivery Systems Research CentreIsfahan University of Medical SciencesIsfahanIran
| |
Collapse
|
15
|
Benezech S, Chabaud S, Chambon F, Dijoud F, Chotel F, Marec-Berard P. Prognostic Value of Vascular Invasion in Pediatric Osteosarcomas. Pathol Oncol Res 2016; 22:847-52. [PMID: 27230613 DOI: 10.1007/s12253-016-0074-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 05/10/2016] [Indexed: 11/24/2022]
Abstract
Metastatic status, histologic response, and quality of surgical resection are prognostic factors for osteosarcomas. Pathology reports sometimes describe peritumoral vascular invasion on surgical specimens after neoadjuvant chemotherapy but their prognostic significance as an independent parameter has never been reported. The aim of this study was to evaluate how the presence of this peritumoral vascular invasion could influence survival. We retrospectively analyzed histology, demographics, and outcomes of pediatric patients treated for osteosarcoma in our institutions between January 2007 and December 2012. A single pathologist analyzed the resection specimens after neoadjuvant chemotherapy. Fifty-one osteosarcomas were diagnosed over a 6-year period; nine had metastatic disease at diagnosis. Surgery was performed after neoadjuvant chemotherapy in all cases. We identified peritumoral vascular invasion in the surgical specimens in 15 cases. Two-year event-free survival (EFS) was 78 % (CI95%[64;93]) for patients without vascular invasion versus 48 % (CI95% [21;75]) in patients with vascular invasion, and 2-year overall survival (OS) was 94 % (CI95%[86;100]) for those without vascular invasion versus 79 % (CI95%[57;100]) for others. Multivariate analysis demonstrated correlation of metastatic status and presence of vascular invasion with survival. The histopathological description of peritumoral vascular invasion in surgical specimens of osteosarcoma after neoadjuvant chemotherapy can be considered a prognostic factor and could indicate modification of the postoperative therapeutic strategy.
Collapse
Affiliation(s)
- Sarah Benezech
- Institut d'Hematologie et Oncologie Pédiatrique, 1 Place Joseph Renaut, 69008, Lyon, France.
| | | | - Fanny Chambon
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - Perrine Marec-Berard
- Institut d'Hematologie et Oncologie Pédiatrique, 1 Place Joseph Renaut, 69008, Lyon, France
| |
Collapse
|
16
|
Vasquez L, Tarrillo F, Oscanoa M, Maza I, Geronimo J, Paredes G, Silva JM, Sialer L. Analysis of Prognostic Factors in High-Grade Osteosarcoma of the Extremities in Children: A 15-Year Single-Institution Experience. Front Oncol 2016; 6:22. [PMID: 26904501 PMCID: PMC4745606 DOI: 10.3389/fonc.2016.00022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/21/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this retrospective study was to define clinical and pathological features and prognostic factors among children and adolescents diagnosed with high-grade osteosarcoma of the extremities. METHODS A total of 73 patients younger than 18 years diagnosed with primary osteosarcoma of the extremities between January 1998 and December 2013 were retrospectively evaluated. Prognostic factors, such as age, gender, primary tumor site, alkaline phosphatase and lactate dehydrogenase levels, metastatic disease, pathological fracture, histological response, and surgery type, were analyzed to evaluate their effects on overall survival (OS) and event-free survival (EFS). RESULTS At a median follow-up of 30 months (1.5-152), OS and EFS at 5 years were 64.5 ± 8.1 and 48.5 ± 8.7% for patients with localized disease; and 16.2 ± 7.9 and 14.4 ± 7.3% for patients with initial metastatic disease, respectively. In patients with localized disease, conservative surgery was performed on 22 of 46 patients (43.5%), and there was no significant difference in survival rates among patients who had conservative vs. radical surgery (p = 0.65). Although tumor size (>12 cm) was significant prognostic factor in univariate analysis; multivariate analysis identified elevated levels of alkaline phosphatase (p = 0.033) and poor response to neoadjuvant chemotherapy (p < 0.001) only as independent prognostic factors. Age, histological type, pathological fracture, and primary tumor site did not significantly affect prognosis. CONCLUSION Initial elevated presence of alkaline phosphatase in serum and poor histological response after neoadjuvant chemotherapy were significant factors for unfavorable prognosis. It is necessary to optimize staging and treatment intensification to improve survival rates, especially among patients with metastasis at initial presentation.
Collapse
Affiliation(s)
- Liliana Vasquez
- Division of Pediatric Oncology, Rebagliati Hospital, Lima, Peru
| | - Fanny Tarrillo
- Division of Pediatric Oncology, Rebagliati Hospital, Lima, Peru
| | - Monica Oscanoa
- Division of Pediatric Oncology, Rebagliati Hospital, Lima, Peru
| | - Ivan Maza
- Division of Pediatric Oncology, Rebagliati Hospital, Lima, Peru
| | - Jenny Geronimo
- Division of Pediatric Oncology, Rebagliati Hospital, Lima, Peru
| | - Gloria Paredes
- Division of Pediatric Oncology, Rebagliati Hospital, Lima, Peru
| | | | - Luis Sialer
- Department of Orthopedics, Rebagliati Hospital, Lima, Peru
| |
Collapse
|
17
|
Roth M, Barris DM, Piperdi S, Kuo V, Everts S, Geller D, Houghton P, Kolb EA, Hawthorne T, Gill J, Gorlick R. Targeting Glycoprotein NMB With Antibody-Drug Conjugate, Glembatumumab Vedotin, for the Treatment of Osteosarcoma. Pediatr Blood Cancer 2016; 63:32-8. [PMID: 26305408 DOI: 10.1002/pbc.25688] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/08/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cure rates for children and young adults with osteosarcoma have remained stagnant over the past three decades. Targeting glycoprotein non-metastatic b (GPNMB) with the antibody-drug conjugate glembatumumab vedotin has improved outcomes for patients with melanoma and breast cancer. The potential utility of targeting GPNMB in osteosarcoma was explored. METHODS GPNMB protein expression was evaluated by immunohistochemistry in human osteosarcoma tumor samples and by enzyme-linked immunosorbent assay (ELISA) in osteosarcoma cell lines. mRNA expression was measured by quantitative PCR in primary osteosarcoma samples and cell lines. Surface GPNMB expression was evaluated by flow cytometry and correlated with in vitro and in vivo cytotoxicity of glembatumumab vedotin. RESULTS Sixty seven human osteosarcoma samples were evaluated by immunohistochemistry, including 12 samples from initial biopsy, 38 samples from definitive surgery, and 17 from the time of disease recurrence. GPNMB was expressed in 92.5% (62/67) of osteosarcoma samples. All primary osteosarcoma samples expressed high levels of GPNMB mRNA. Glembatumumab induced cytotoxic effects in 74% (14/19) of osteosarcoma cell lines, and GPNMB protein levels correlated with glembatumumab in vitro cytotoxicity (r = -0.46, P = 0.04). All osteosarcoma cell lines demonstrated surface GPNMB expression. CONCLUSIONS GPNMB is expressed in osteosarcoma and targeting GPNMB with the antibody-drug conjugate glembatumumab vedotin demonstrates osteosarcoma cytotoxic activity. Clinical trials are indicated to assess the efficacy of targeting GPNMB in patients with osteosarcoma.
Collapse
Affiliation(s)
- Michael Roth
- Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - David M Barris
- Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Sajida Piperdi
- Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Vicky Kuo
- Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Stephanie Everts
- Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - David Geller
- Department of Orthopaedic Surgery, Montefiore Medical Center and the Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Peter Houghton
- Greehey Children's Cancer Research Institute, University of Texas Health Science Center, San Antonio, Texas
| | - E Anders Kolb
- Division of Pediatric Hematology/Oncology, A.I. duPont Hospital for Children, Wilmington, Delaware
| | | | - Jonathan Gill
- Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Richard Gorlick
- Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York.,Department of Pediatrics and Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
18
|
Analysis of Chemotherapy Dosage and Dosage Intensity and Survival Outcomes of High-Grade Osteosarcoma Patients Younger Than 40 Years. Clin Ther 2014; 36:567-78. [DOI: 10.1016/j.clinthera.2014.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 01/27/2014] [Accepted: 02/18/2014] [Indexed: 11/20/2022]
|
19
|
Abstract
Osteosarcoma is a malignant tumor that primarily affects the long bones but can also involve other bones in the body. It has a bimodal distribution with peaks in the second decade of life and late adulthood. This chapter will highlight the clinical presentation, diagnosis, and treatment of osteosarcoma.
Collapse
|
20
|
Finney J, Kent PM, Batus M. Future directions for pediatric and young adult bone sarcoma. Curr Probl Cancer 2013; 37:225-35. [PMID: 24238588 DOI: 10.1016/j.currproblcancer.2013.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
21
|
Collins M, Wilhelm M, Conyers R, Herschtal A, Whelan J, Bielack S, Kager L, Kühne T, Sydes M, Gelderblom H, Ferrari S, Picci P, Smeland S, Eriksson M, Petrilli AS, Bleyer A, Thomas DM. Benefits and Adverse Events in Younger Versus Older Patients Receiving Neoadjuvant Chemotherapy for Osteosarcoma: Findings From a Meta-Analysis. J Clin Oncol 2013; 31:2303-12. [DOI: 10.1200/jco.2012.43.8598] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The LIVESTRONG Young Adult Alliance has conducted a meta-analysis of individual patient data from prospective neoadjuvant chemotherapy osteosarcoma studies and registries to examine the relationships of sex, age, and toxicity on survival. Patients and Methods Suitable data sets were identified by a survey of published data reported in PubMed. The final pooled data set comprised 4,838 patients from five international cooperative groups. Results After accounting for important variables known at study entry such as tumor location and histology, females experienced higher overall survival rates than males (P = .005) and children fared better than adolescents and adults (P = .002). Multivariate landmark analysis following surgery indicated that a higher rate of chemotherapy-induced tumor necrosis was associated with longer survival (P < .001), as was female sex (P = .004) and the incidence of grade 3 or 4 mucositis (P = .03). Age group was not statistically significant in this landmark analysis (P = .12). Females reported higher rates of grade 3 or 4 thrombocytopenia relative to males (P < .001). Children reported the highest rates of grade 3 or 4 neutropenia (P < .001) and thrombocytopenia (P < .001). The achievement of good tumor necrosis was higher for females than for males (P = .002) and for children than for adults (P < .001). Conclusion These results suggest fundamental differences in the way chemotherapy is handled by females compared with males and by children compared with older populations. These differences may influence survival in a disease in which chemotherapy is critical to overall outcomes.
Collapse
Affiliation(s)
- Marnie Collins
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Miriam Wilhelm
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Rachel Conyers
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Alan Herschtal
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Jeremy Whelan
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Stefan Bielack
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Leo Kager
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Thomas Kühne
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Matthew Sydes
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Hans Gelderblom
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Stefano Ferrari
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Piero Picci
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Sigbjørn Smeland
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Mikael Eriksson
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Antonio Sérgio Petrilli
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - Archie Bleyer
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| | - David M. Thomas
- Marnie Collins, Rachel Conyers, Alan Herschtal, and David M. Thomas, Peter MacCallum Cancer Centre and Australasian Sarcoma Study Group, Melbourne, Australia; Jeremy Whelan, University College London Hospitals; Matthew Sydes, Medical Research Council Clinical Trials Unit, London, United Kingdom; Hans Gelderblom, European Osteosarcoma Intergroup and University Medical Centre, Leiden, the Netherlands; Miriam Wilhelm and Stefan Bielack, Cooperative Osteosarcoma Study Group and Klinikum Stuttgart,
| |
Collapse
|
22
|
Kuroda M, Hashiguchi H, Nakagawa S, Geng Z. MCMC using Markov bases for computing $$p$$ -values in decomposable log-linear models. Comput Stat 2013. [DOI: 10.1007/s00180-012-0331-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
23
|
van Maldegem AM, Bhosale A, Gelderblom HJ, Hogendoorn PC, Hassan AB. Comprehensive analysis of published phase I/II clinical trials between 1990-2010 in osteosarcoma and Ewing sarcoma confirms limited outcomes and need for translational investment. Clin Sarcoma Res 2012; 2:5. [PMID: 22587841 PMCID: PMC3351714 DOI: 10.1186/2045-3329-2-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 01/27/2012] [Indexed: 02/01/2023] Open
Abstract
Background High grade primary bone sarcomas are rare cancers that affect mostly children and young adults. Osteosarcoma and Ewing sarcoma are the most common histological subtypes in this age group, with current multimodality treatment strategies achieving 55-70% overall survival. As there remains an urgent need to develop new therapeutic interventions, we have reviewed published phase I/II trials that have been reported for osteosarcoma and Ewing sarcoma in the last twenty years. Results We conducted a literature search for clinical trials between 1990 and 2010, either for trials enrolling bone sarcoma patients as part of a general sarcoma indication or trials specifically in osteosarcoma and Ewing sarcoma. We identified 42 clinical trials that fulfilled our search criteria for general sarcoma that enrolled these patient groups, and eight and twenty specific trials for Ewing and osteosarcoma patients, respectively. For the phase I trials which enrolled different tumour types our results were incomplete, because the sarcoma patients were not mentioned in the PubMed abstract. A total of 3,736 sarcoma patients were included in these trials over this period, 1,114 for osteosarcoma and 1,263 for Ewing sarcoma. As a proportion of the worldwide disease burden over this period, these numbers reflect a very small percentage of the potential patient recruitment, approximately 0.6% for Ewing sarcoma and 0.2% for osteosarcoma. However, these data show an increase in recent activity overall and suggest there is still much room for improvement in the current trial development structures. Conclusion Lack of resources and commercial investment will inevitably limit opportunity to develop sufficiently rapid improvements in clinical outcomes. International collaboration exists in many well founded co-operative groups for phase III trials, but progress may be more effective if there were also more investment of molecular and translational research into disease focused phase I/II clinical trials. Examples of new models for early translational and early phase trial collaboration include the European based EuroBoNeT network, the Sarcoma Alliance for Research through Collaboration network (SARC) and the new European collaborative translational trial network, EuroSarc.
Collapse
Affiliation(s)
- Annemiek M van Maldegem
- Department of Oncology, Oxford Cancer and Haematology Centre, Churchill Hospital, University of Oxford, Oxford OX3 7LJ, UK
| | - Aparna Bhosale
- Department of Oncology, Oxford Cancer and Haematology Centre, Churchill Hospital, University of Oxford, Oxford OX3 7LJ, UK
| | - Hans J Gelderblom
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, PO Box 9600, 2600 RC Leiden, The Netherlands
| | - Pancras Cw Hogendoorn
- Department of Pathology, Leiden University Medical Center, Leiden, PO Box 9600, 2600 RC Leiden, The Netherlands
| | - Andrew B Hassan
- Department of Oncology, Oxford Cancer and Haematology Centre, Churchill Hospital, University of Oxford, Oxford OX3 7LJ, UK.,Sir William Dunn School of Pathology, South Parks Road, University of Oxford, Oxford OX1 3RE, UK
| |
Collapse
|
24
|
Huang G, Yu L, Cooper LJ, Hollomon M, Huls H, Kleinerman ES. Genetically modified T cells targeting interleukin-11 receptor α-chain kill human osteosarcoma cells and induce the regression of established osteosarcoma lung metastases. Cancer Res 2011; 72:271-81. [PMID: 22075555 DOI: 10.1158/0008-5472.can-11-2778] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The treatment of osteosarcoma pulmonary metastases remains a challenge. T cells genetically modified to express a chimeric antigen receptor (CAR), which recognizes a tumor-associated antigen, have shown activity against hematopoietic malignancies in clinical trials, but this requires the identification of a specific receptor on the tumor cell. In the current study, we found that interleukin (IL)-11Rα was selectively expressed on 14 of 16 osteosarcoma patients' lung metastases and four different human osteosarcoma cell lines, indicating that IL-11Rα may be a novel target for CAR-specific T-cell therapy. IL-11Rα expression was absent or low in normal organ tissues, with the exception of the gastrointestinal tract. IL-11Rα-CAR-specific T cells were obtained by non-viral gene transfer of Sleeping Beauty DNA plasmids and selectively expanded ex vivo using artificial antigen-presenting cells derived from IL-11Rα + K562 cells genetically modified to coexpress T-cell costimulatory molecules. IL-11Rα-CAR(+) T cells killed all four osteosarcoma cell lines in vitro; cytotoxicity correlated with the level of IL-11Rα expression on the tumor cells. Intravenous injection of IL-11Rα-CAR(+) T cells into mice resulted in the regression of osteosarcoma pulmonary metastases with no organ toxicity. Together, the data suggest that IL-11Rα-CAR T cells may represent a new therapy for patients with osteosarcoma pulmonary metastases.
Collapse
Affiliation(s)
- Gangxiong Huang
- Division of Pediatrics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Ling Yu
- Division of Pediatrics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Laurence Jn Cooper
- Division of Pediatrics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Mario Hollomon
- Division of Pediatrics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Helen Huls
- Division of Pediatrics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Eugenie S Kleinerman
- Division of Pediatrics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| |
Collapse
|
25
|
LIN F, WANG Q, YU W, TANG L, ZHENG S, SUN Y, SHEN Z, YAO Y, DONG Y. Clinical analysis of Chinese limb osteosarcoma patients treated by two combinations of methotrexate, cisplatin, doxorubicin and ifosfamide. Asia Pac J Clin Oncol 2011; 7:270-5. [DOI: 10.1111/j.1743-7563.2011.01406.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
26
|
Jawad MU, Cheung MC, Clarke J, Koniaris LG, Scully SP. Osteosarcoma: improvement in survival limited to high-grade patients only. J Cancer Res Clin Oncol 2010; 137:597-607. [PMID: 20514491 DOI: 10.1007/s00432-010-0923-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 05/19/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND We sought to identify the significant prognostic parameters of patients with osteosarcoma over the past three decades using a population-based registry. METHODS A total of 3765 patients with osteosarcoma were identified in the SEER database. Information regarding patient demographics, clinical and treatment characteristics, cause of death and survival were extracted. Kaplan-Meier, Log-Rank, and Cox regression were used for analysis. RESULTS On multivariate analysis only age group '<25 years', 'local' stage and 'low' grade, 'appendicular skeleton' and employment of 'surgical resection' showed a disease-specific survival benefit with a P value < 0.001. The long-term survival improved in the interval from 1973 to 1985 from approximately 55 to 65% but subsequent improvement has been limited only to patients with high-grade disease. CONCLUSION When comparing survival rates by decade of diagnosis, it appears that improvement in survival since 1985 is limited to patients with high-grade disease only. LEVEL OF EVIDENCE The level of evidence for this article is 2.
Collapse
Affiliation(s)
- Muhammad Umar Jawad
- Department of Orthopaedics, University of Miami Miller School of Medicine, University of Miami Hospital, 4th Floor, 1400 NW, 12th Avenue, Miami, FL 33136, USA
| | | | | | | | | |
Collapse
|
27
|
|
28
|
Shahbaba B, Gentles AJ, Beyene J, Plevritis SK, Greenwood CM. A Bayesian nonparametric method for model evaluation: application to genetic studies. J Nonparametr Stat 2009. [DOI: 10.1080/10485250802613558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
29
|
Bispo Júnior RZ, Camargo OPD. Prognostic factors in the survival of patients diagnosed with primary non-metastatic osteosarcoma with a poor response to neoadjuvant chemotherapy. Clinics (Sao Paulo) 2009; 64:1177-86. [PMID: 20037705 PMCID: PMC2797586 DOI: 10.1590/s1807-59322009001200007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 09/17/2009] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Identification of variables that determine the prognosis for osteosarcoma may enable stratification of patients into subgroups with better or worse risk of local recurrence, metastases and death due to the disease. Discovery of such prognostic factors would permit selection of a subgroup of at-risk patients, with the aim of improving the therapeutic effectiveness. OBJECTIVE To identify prognostic factors related to local recurrence-free survival, metastasis-free survival and overall survival among patients with highly malignant primary osteosarcoma that was non-metastatic on diagnosis and had poor response to neoadjuvant chemotherapy. SAMPLE AND METHODS Out of 45 patients admitted to a referral center in Brazil between 2000 and 2004, 24 were selected for this study. RESULTS The adverse factors that influenced the risk of local recurrence and the overall survival in univariate analysis were histological subtype other than osteoblastic (p = 0.017) and tumor size greater than 15 cm (p = 0.048). In relation to metastasis-free survival, the non-osteoblastic subtype had a worse prognosis (p = 0.007). The association of histological subtype maintained its significance in multivariate analysis for all studied survival categories. CONCLUSIONS Tumor size greater than 15 cm is an adverse factor for local recurrence-free survival and overall survival but did not influence metastasis-free survival. The osteosarcoma histological type is a significant independent predictor for local recurrence-free survival, metastasis-free survival and overall survival.
Collapse
|
30
|
Jaffe N. Adjuvant chemotherapy in osteosarcoma: an odyssey of rejection and vindication. Cancer Treat Res 2009; 152:219-37. [PMID: 20213393 DOI: 10.1007/978-1-4419-0284-9_11] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Norman Jaffe
- Children's Cancer Hospital, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit #87, Houston, TX 77030-4009, USA.
| |
Collapse
|
31
|
Complications and risk factors for failure of rotationplasty: review of 25 patients. Clin Orthop Relat Res 2008; 466:1302-8. [PMID: 18404295 PMCID: PMC2384038 DOI: 10.1007/s11999-008-0231-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Accepted: 03/07/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Rotationplasty is one treatment option for femoral bone sarcomas in skeletally immature patients. This procedure enables patients to avoid phantom pain, limb length discrepancy, or loosening of an endoprosthesis, and good functional outcome has been reported. However, rotationplasty is only rarely indicated and the surgical complications or risk factors for failure of the procedure that might influence choices of treatment or patient counseling have not been well described. We reviewed 25 patients who underwent rotationplasty focusing on risk factors for failure and postoperative complications. Three of 25 patients had vascular compromise resulting in amputation. All three had vascular anastomosis and were resistant to chemotherapy with less than 95% of tumor necrosis. Two of the three patients who underwent amputation had a pathologic fracture before surgery. Late complications included one patient with a tibial fracture, two with wound complications treated with skin grafts, one with nonunion, and one with subsequent slipped capital femoral epiphysis. Rotationplasty was successfully accomplished in 22 of the 25 patients. Patients with large tumors unresponsive to chemotherapy or preoperative pathologic fracture appear at higher risk for failure of rotationplasty presumably as a result of compromise of venous drainage of the leg. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Collapse
|
32
|
|
33
|
Picci P. Osteosarcoma: What did we learn from the paediatric experience for adolescents and young adults? EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70044-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
34
|
Bacci G, Longhi A, Versari M, Mercuri M, Briccoli A, Picci P. Prognostic factors for osteosarcoma of the extremity treated with neoadjuvant chemotherapy: 15-year experience in 789 patients treated at a single institution. Cancer 2006; 106:1154-61. [PMID: 16421923 DOI: 10.1002/cncr.21724] [Citation(s) in RCA: 415] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
Collapse
Affiliation(s)
- Gaetano Bacci
- Department of Chemotherapy, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
35
|
Bacci G, Longhi A, Fagioli F, Briccoli A, Versari M, Picci P. Adjuvant and neoadjuvant chemotherapy for osteosarcoma of the extremities: 27 year experience at Rizzoli Institute, Italy. Eur J Cancer 2005; 41:2836-45. [PMID: 16298125 DOI: 10.1016/j.ejca.2005.08.026] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Revised: 08/10/2005] [Accepted: 08/10/2005] [Indexed: 11/23/2022]
Abstract
Around 1148 patients with non-metastatic osteosarcoma of the extremity were treated in a single institution between 1972 and 1999 with 4 different protocol of adjuvant and 7 different protocols of neoadjuvant chemotherapy. The rate of limb salvage increased from 20% to 71%. The 5-year event-free survival (EFS) and overall survival (OS) were 57% and 66%, respectively. The 10-year EFS and OS were 52% and 57%, respectively, and the results significantly correlated with serum alkaline phosphatase levels; the type of chemotherapy (adjuvant vs neoadjuvant); and with histologic response to pre-operative treatment. Aggressive chemotherapy and surgery could cure about the 60% of patients with osteosarcoma of the extremity. However, since local or systemic relapses, myocardiopathies and a second malignancy are possible even 5 or more years since the beginning of treatment, a long-term follow-up is recommended.
Collapse
Affiliation(s)
- Gaetano Bacci
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
36
|
Gordon N, Arndt CAS, Hawkins DS, Doherty DK, Inwards CY, Munsell MF, Stewart J, Koshkina NV, Kleinerman ES. Fas expression in lung metastasis from osteosarcoma patients. J Pediatr Hematol Oncol 2005; 27:611-5. [PMID: 16282894 DOI: 10.1097/01.mph.0000188112.42576.df] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors' animal studies have shown that the metastatic potential of osteosarcoma (OS) cells correlates inversely with Fas expression-that is, Fas-negative cells metastasize but Fas-positive cells do not. One reason for this in the context of OS lung metastases may be that Fas-positive cells are eliminated by engagement with the Fas ligand (FasL) constitutively expressed on the surface of pneumocytes, whereas Fas-negative tumor cells are not. The purpose of this study was to determine the status of Fas expression in OS lung metastases from patients. Specifically, archived paraffin-embedded specimens of lung metastases from 38 patients with OS were analyzed by immunohistochemistry. Lung nodules from 23 of the 38 patients (60%) were Fas negative, those from 12 patients (32%) were weakly positive, and that from only 1 patient (3%) was strongly positive. Findings in the samples from the remaining two patients (5%) could not be interpreted because of extensive necrosis. Most patients with the weakly positive tumors and the single patient with the strongly positive tumor received chemotherapy prior to lung resection. There was a significant correlation between Fas expression and the administration of preoperative salvage chemotherapy (P = 0.0013). These data indicate that loss of Fas may be one mechanism by which OS cells evade host resistance in the lung. Chemotherapy may induce regression by upregulating Fas.
Collapse
Affiliation(s)
- Nancy Gordon
- Division of Pediatrics, Department of Cancer Biology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, and Division of Pediatrics Hematology/Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Yang B, Kolassa JE. A refinement to approximate conditional inference. Stat Probab Lett 2005. [DOI: 10.1016/j.spl.2004.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
38
|
Bacci G, Longhi A, Bertoni F, Bacchini P, Ruggeri P, Versari M, Picci P. Primary high-grade osteosarcoma: comparison between preadolescent and older patients. J Pediatr Hematol Oncol 2005; 27:129-34. [PMID: 15750443 DOI: 10.1097/01.mph.0000155860.38641.83] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
Collapse
Affiliation(s)
- Gaetano Bacci
- Department of Chemotherapy, Istituti Ortopedici Rizzoli, Bologna, Italy.
| | | | | | | | | | | | | |
Collapse
|
39
|
Minard-Colin V, Kalifa C, Guinebretiere JM, Brugieres L, Dubousset J, Habrand JL, Vassal G, Hartmann O. Outcome of flat bone sarcomas (other than Ewing's) in children and adolescents: a study of 25 cases. Br J Cancer 2004; 90:613-9. [PMID: 14760373 PMCID: PMC2409588 DOI: 10.1038/sj.bjc.6601564] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We analysed the clinical features and outcome of young patients with non-Ewing's flat bone sarcoma treated during the era of contemporary chemotherapy. The characteristics and outcome of 25 patients (15 males and 10 females) with primary or radiation-related flat bone sarcoma treated in the Pediatrics Department at the Institut Gustave Roussy from 1981 to 1999 were reviewed. In all, 20 patients had osteosarcoma, four chondrosarcoma and one malignant fibrous histiocytoma. The age at diagnosis ranged from 2 to 23 years (median, 15 years). Nine tumours were located in the craniofacial bones, 11 in the pelvis and five in flat bones at other sites. Four patients had metastatic disease at diagnosis. Radiation-associated flat bone osteosarcoma was diagnosed in 10 out of 25 cases. The projected overall survival and event-free survival (EFS) rates at 5 years were 45.1 and 34.3% for all the 25 patients. The EFS rate of patients with second bone sarcoma was similar to that of patients with de novo flat bone sarcoma (P=0.1). The aim of treatment was curative for 24 patients, 23 of whom were treated with intensive chemotherapy regimens and 19 with surgery. Significant adverse prognostic factors on survival included incomplete surgical resection (P=0.001) and use of regimens without pre- and postoperative chemotherapy (P=0.007). Nine of the 25 patients were treated with pre- and postoperative chemotherapy and complete surgical resection. Among them, eight are alive with no disease. Radical surgical resection is the overriding prognostic factor for flat bone sarcomas in young patients. Nevertheless, our results suggest a more favourable outcome since the advent of intensive chemotherapy.
Collapse
Affiliation(s)
- V Minard-Colin
- Department of Pediatrics, Institut Gustave Roussy, 39 rue Camille Desmoulins, Villejuif Cedex 94805, France
| | - C Kalifa
- Department of Pediatrics, Institut Gustave Roussy, 39 rue Camille Desmoulins, Villejuif Cedex 94805, France
| | - J-M Guinebretiere
- Department of Pathology, Institut Gustave Roussy, 39 rue Camille Desmoulins, Villejuif Cedex 94805, France
| | - L Brugieres
- Department of Pediatrics, Institut Gustave Roussy, 39 rue Camille Desmoulins, Villejuif Cedex 94805, France
| | - J Dubousset
- Department of Pediatrics, Institut Gustave Roussy, 39 rue Camille Desmoulins, Villejuif Cedex 94805, France
| | - J-L Habrand
- Department of Radiotherapy, Institut Gustave Roussy, 39 rue Camille Desmoulins, Villejuif Cedex 94805, France
| | - G Vassal
- Department of Pediatrics, Institut Gustave Roussy, 39 rue Camille Desmoulins, Villejuif Cedex 94805, France
| | - O Hartmann
- Department of Pediatrics, Institut Gustave Roussy, 39 rue Camille Desmoulins, Villejuif Cedex 94805, France
- Department of Pediatrics, Institut Gustave Roussy, 39 rue Camille Desmoulins, Villejuif Cedex 94805, France. E-mail:
| |
Collapse
|
40
|
Oster RA. An Examination of Statistical Software Packages for Categorical Data Analysis Using Exact Methods—Part II. AM STAT 2003. [DOI: 10.1198/0003130031928] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
41
|
Goorin AM, Schwartzentruber DJ, Devidas M, Gebhardt MC, Ayala AG, Harris MB, Helman LJ, Grier HE, Link MP. Presurgical chemotherapy compared with immediate surgery and adjuvant chemotherapy for nonmetastatic osteosarcoma: Pediatric Oncology Group Study POG-8651. J Clin Oncol 2003; 21:1574-80. [PMID: 12697883 DOI: 10.1200/jco.2003.08.165] [Citation(s) in RCA: 300] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Successful therapeutic interventions to prevent disease progression in patients with nonmetastatic osteosarcoma have included surgery with adjuvant chemotherapy. Presurgical chemotherapy has been advocated for these patients because of putative improvement in event-free survival (EFS). The advantages of presurgical chemotherapy include early administration of systemic chemotherapy, shrinkage of primary tumor, and pathologic identification of risk groups. The theoretic disadvantage is that it exposes a large tumor burden to marginally effective chemotherapy. The contribution of chemotherapy and surgery timing has not been tested rigorously. PATIENTS AND METHODS Between 1986 and 1993, we conducted a prospective trial in patients with nonmetastatic osteosarcoma who were assigned randomly to immediate surgery or presurgical chemotherapy. Except for the timing of surgery (week 0 or 10), patients received 44 weeks of identical combination chemotherapy that included high-dose methotrexate with leucovorin rescue, doxorubicin, cisplatin, bleomycin, cyclophosphamide, and dactinomycin. RESULTS One hundred six patients were enrolled onto this study. Six were excluded from analysis. Of the remaining 100 patients, 45 were randomly assigned to immediate chemotherapy, and 55 were randomly assigned to immediate surgery. Sixty-seven patients remain disease-free. At 5 years, the projected EFS +/- SE is 65% +/- 6% (69% +/- 8% for immediate surgery and 61% +/- 8% for presurgical chemotherapy; P =.8). The treatment arms had similar incidence of limb salvage (55% for immediate surgery and 50% for presurgical chemotherapy). CONCLUSION Chemotherapy was effective in both treatment groups. There was no advantage in EFS for patients given presurgical chemotherapy.
Collapse
Affiliation(s)
- Allen M Goorin
- Dana-Farber Cancer Institute, 44 Binney St, Boston, MA 02115, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
Applications of saddlepoint approximations to distribution functions are reviewed. Calculations are provided for marginal distributions and conditional distributions. These approximations are applied to problems of testing and generating confidence intervals, particularly in canonical exponential families.
Collapse
Affiliation(s)
- J E Kolassa
- Department of Statistics, Rutgers University, Piscataway, NJ 08854-8019 USA.
| |
Collapse
|
43
|
Bielack SS, Kempf-Bielack B, Delling G, Exner GU, Flege S, Helmke K, Kotz R, Salzer-Kuntschik M, Werner M, Winkelmann W, Zoubek A, Jürgens H, Winkler K. 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 2002; 20:776-90. [PMID: 11821461 DOI: 10.1200/jco.2002.20.3.776] [Citation(s) in RCA: 1304] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To define prognostic factors for response and long-term outcome for a wide spectrum of osteosarcomas, extending well beyond those of the typical young patient with seemingly localized extremity disease. PATIENTS AND METHODS A total of 1,702 consecutive newly diagnosed patients with high-grade osteosarcoma of the trunk or limbs registered into the neoadjuvant studies of the Cooperative Osteosarcoma Study Group before July 1998 were entered into an analysis of demographic, tumor-related, and treatment-related variables, response, and survival. The intended therapeutic strategy included preoperative and postoperative chemotherapy with multiple agents as well as surgery of all operable lesions. RESULTS Axial tumor site, male sex, and a long history of symptoms were associated with poor response to chemotherapy in univariate and multivariate analysis. Actuarial 10-year overall and event-free survival rates were 59.8% and 48.9%. Among the variables assessable at diagnosis, patient age (actuarial 10-year survival > or = 40, 41.6%; < 40, 60.2%; P =.012), tumor site (axial, 29.2%; limb, 61.7%; P <.0001), and primary metastases (yes, 26.7%; no, 64.4%; P <.0001), and for extremity osteosarcomas, also size (> or = one third, 52.5%; < one third, 66.7%; P <.0001) and location within the limb (proximal, 49.3%; other, 63.9%; P <.0001), had significant influence on outcome. Two additional important prognostic factors were treatment related: response to chemotherapy (poor, 47.2%; good, 73.4%; P <.0001) and the extent of surgery (incomplete, 14.6%; macroscopically complete, 64.8%; P <.0001). All factors except age maintained their significance in multivariate testing, with surgical remission and histologic response emerging as the key prognostic factors. CONCLUSION Tumor site and size, primary metastases, response to chemotherapy, and surgical remission are of independent prognostic value in osteosarcoma.
Collapse
Affiliation(s)
- Stefan S Bielack
- Klinik und Poliklinik für Kinderheilkunde, Pädiatrische Hämatologie/Onkologie, Universitätsklinikum, Münster, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
Osteosarcoma is the most frequently occurring primary malignant tumor of bone, especially in adolescence. Treatment involves either limb salvage surgery or amputation with neoadjuvant chemotherapy. This review article discusses the current treatment modalities for osteosarcoma and also compares the gait patterns and psychosocial profiles of patients treated with either limb salvage surgery or amputation for osteosarcoma. Contemporary orthopedic literature on therapeutic options for osteosarcoma patients is reviewed. Background information on the basic principles of kinesiology, with emphasis on studies of gait pattern differences among patients treated with limb salvage versus amputation, is presented. Finally, several studies of the psychologic profiles of patients after these two procedures for osteosarcoma are reviewed. Trends in contemporary orthopedic literature suggest that functional outcomes, in terms of kinesiologic parameters, are comparable for patients treated with either limb salvage or amputation. Both sets of patients reported quality-of-life problems, including difficulty retaining health insurance and finding appropriate employment, social isolation, and poor self-esteem. The management of patients with osteosarcoma includes not only an individualized surgical plan for each patient but also includes awareness of the patients' psychologic and social needs after surgery.
Collapse
Affiliation(s)
- J M Lane
- Department of Orthopedic Surgery, Weill Medical College of Cornell University, Hospital for Special Surgery, New York, New York 10021, USA.
| | | | | | | |
Collapse
|
45
|
Abstract
The authors review their lengthy experience in treating high grade osteosarcoma of the extremity. During the past 20 years many advances have been made in treating high grade osteosarcoma of the extremity. Twenty years ago, in spite of amputation, most patients with this tumor died, whereas today most are cured and amputation is avoided. These advances are mainly due to the development of effective adjuvant and neoadjuvant chemotherapy regimens. This review reports on the progress and controversies in the treatment of osteosarcoma.
Collapse
Affiliation(s)
- G Bacci
- Dept. of Musculoskeletal Oncology of the Istituto Ortopedico Rizzoli, Bologna, Italy.
| | | |
Collapse
|
46
|
Abstract
A comprehensive multidisciplinary approach has transformed osteosarcoma from a disease with a modest long-term survival to one in which at least two-thirds of patients will be cured. Surgery remains the vital modality for treating the primary tumor, whereas adjuvant chemotherapy plays an essential role in the control of subclinical metastatic disease. Complete surgical excision of the primary tumor remains an essential element of treatment. For many patients, a combination of advances in surgical technique, improved imaging modalities to accurately document tumor extent, and the effect of neoadjuvant chemotherapy has made limb salvage procedures a safe alternative to amputation. In some patients for whom complete surgical excision is impossible, the addition of radiation therapy may allow local tumor control. The most effective chemotherapy agents currently in use include high-dose methotrexate, doxorubicin, cisplatin, and ifosfamide/etoposide. The optimal schedule of therapy is still being investigated, as is the role of dose intensification. Unfortunately, some groups of patients remain at high risk of eventual relapse. Those whose tumors show relatively low degrees of necrosis after administration of chemotherapy have poorer survival than patients with more chemotherapy-responsive tumors. Similarly, patients who present with overt metastatic disease (particularly bone metastases), as well as patients with tumors that recur after treatment, continue to have an unsatisfactory outcome. These groups, in particular, may benefit from future investigations into novel agents, such as biological response modifiers, antiangiogenesis factors, and growth receptor modulation.
Collapse
Affiliation(s)
- W S Ferguson
- Division of Pediatric Hematology-Oncology, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
| | | |
Collapse
|
47
|
Bacci G, Ferrari S, Bertoni F, Picci P, Bacchini P, Longhi A, Donati D, Forni C, Campanacci L, Campanacci M. Histologic response of high-grade nonmetastatic osteosarcoma of the extremity to chemotherapy,. Clin Orthop Relat Res 2001:186-96. [PMID: 11347833 DOI: 10.1097/00003086-200105000-00024] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In 510 patients with osteosarcoma of the extremity treated at the authors' institute between March 1983 and June 1995 with different regimens of neoadjuvant chemotherapy, factors that influenced the histologic response were investigated. The rate of total necrosis was not related to the patients' gender, age, site, size of tumor, serum of alkaline phosphatase values, or route of cisplatin administration. The histologic response significantly and independently correlated with the number of drugs administered before surgery and with the histologic subtype of the tumor. According to the number of drugs used, the percentage of total necrosis was 31% for a four-drug regimen, 18% for a three-drug regimen, and only 1.5% for a two-drug regimen. According to the histologic type, the rates of total necrosis were 41% for telangiectatic tumors, 36% for fibroblastic tumors, 15% for osteoblastic tumors, and 3% for chondroblastic tumors. The authors concluded that in neoadjuvant therapy of osteosarcoma, the histologic response to preoperative treatment, which correlates with prognosis, depends on the effectiveness of the chemotherapy regimen and on some features intrinsically inherent to the tumor. These data should be considered when selecting the type of treatment (adjuvant or neoadjuvant) and the combinations of drugs to be used in preoperative treatment of patients with osteosarcoma.
Collapse
Affiliation(s)
- G Bacci
- Service of Chemotherapy, Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Bacci G, Ferrari S, Longhi A, Perin S, Forni C, Fabbri N, Salduca N, Versari M, Smith KV. Pattern of relapse in patients with osteosarcoma of the extremities treated with neoadjuvant chemotherapy. Eur J Cancer 2001; 37:32-8. [PMID: 11165127 DOI: 10.1016/s0959-8049(00)00361-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
570 patients with osteosarcoma of the extremities were treated with five different protocols of neoadjuvant chemotherapy at Rizzoli Institute between 1983 and 1995. Surgery consisted of limb salvage in 83% rotation plasty in 5% and amputation in 12%. The 5-year event-free survival (EFS) was 60% which varied according to the protocol followed, ranging from 47.6% to 66.4%. 234 patients relapsed. The pattern of relapse was analysed. The mean relapse time was 23.8 months (range: 2-96). The first site of systemic relapse was the lung in 88% (32% of these had less than three pulmonary metastases and 68% three or more), bone in 9%, lung and bone in 2% and other sites in 3%. The relapse time and the number of pulmonary metastases were strictly correlated with the efficacy of the protocol of chemotherapy used. Patients treated with the three protocols that gave a 5-year EFS of more than 60% relapsed later and had fewer pulmonary lesions than patients treated with the two protocols that gave a 5-year EFS of 47.6% and 52.5%. The rate of local recurrence was relatively low (6%). This was not correlated with the protocol or the type of surgery used: limb salvage (6.4%), rotation plasty or amputation (4.1%). However, the rate of local recurrence was very high (21.9%) in the few patients (7%) that had less than wide surgical margins. We conclude that for patients with osteosarcoma of the extremities treated with neoadjuvant chemotherapy: (a) the pattern of systemic relapse changes according to the efficacy of the protocol of chemotherapy used. This should be always considered when evaluating the preliminary results of new studies as well as in defining the time of follow-up; (b) limb salvage procedures are safe and do not jeopardise the outcome of the patient, provided that wide surgical margins are achieved.
Collapse
Affiliation(s)
- G Bacci
- Service of Chemotherapy, Rizzoli Orthopedic Institute, Via Pupilli, 40136, Bologna, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Bacci G, Ferrari S, Bertoni F, Ruggieri P, Picci P, Longhi A, Casadei R, Fabbri N, Forni C, Versari M, Campanacci M. Long-term outcome for patients with nonmetastatic osteosarcoma of the extremity treated at the istituto ortopedico rizzoli according to the istituto ortopedico rizzoli/osteosarcoma-2 protocol: an updated report. J Clin Oncol 2000; 18:4016-27. [PMID: 11118462 DOI: 10.1200/jco.2000.18.24.4016] [Citation(s) in RCA: 272] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE 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 AND METHODS 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. RESULTS 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. CONCLUSION 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.
Collapse
Affiliation(s)
- G Bacci
- Service of Chemotherapy, Laboratory of Pathology, Fifth Service of Orthopedic Surgery, and Laboratory of Oncologic Research, Department of Musculoskeletal Oncology, I.F. Goidanich of the Istituto Ortopedico Rizzoli, Bologna, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Kolassa JE. Saddlepoint approximation at the edges of a conditional sample space. Stat Probab Lett 2000. [DOI: 10.1016/s0167-7152(00)00101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|