Survival of pediatric patients after relapsed osteosarcoma: the St. Jude Children's Research Hospital experience

Abstract

Background: Chemotherapy has improved the outcome of patients with newly diagnosed osteosarcoma, but its role in relapsed disease is unclear.

Methods: We reviewed the records of all patients who were treated for relapsed high-grade osteosarcoma at our institution between 1970 and 2004. Postrelapse event-free survival (PREFS) and postrelapse survival (PRS) were estimated, and outcome comparisons were made using an exact log-rank test.

Results: The 10-year PREFS and PRS of the 110 patients were 11.8% ± 3.5% and 17.0% ± 4.3%, respectively. Metastasis at initial diagnosis (14%), and relapse in lung only (75%) were not significantly associated with PREFS or PRS. Time from initial diagnosis to first relapse (RL1) ≥18 months (43%), surgery at RL1 (76%), and ability to achieve second complete remission (CR2, 56%) were favorably associated with PREFS and PRS (P ≤ 0.0002). In patients without CR2, chemotherapy at RL1 was favorably associated with PREFS (P = 0.01) but not with PRS. In patients with lung relapse only, unilateral relapse and number of nodules ( ≤ 3) were associated with better PREFS and PRS (P ≤ 0.0005); no patients with bilateral relapse survived 10 years. The median PREFS after treatment with cisplatin, doxorubicin, methotrexate, and ifosfamide was 3.5 months (95% confidence interval, 2.1-5.2), and the median PRS was 8.2 months (95% confidence interval, 5.2-15.1).

Conclusions: Late relapse, surgical resection, and unilateral involvement (in lung relapse only) favorably impact outcome after relapse. Surgery is essential for survival; chemotherapy may slow disease progression in patients without CR2. These data are useful for designing clinical trials that evaluate novel agents.

Keywords: chemotherapy; osteosarcoma; outcome; prognostic factors; relapse; survival.

© 2013 American Cancer Society.

Figures

Figure 1

Number of relapse, number of complete remission (CR), and life status of all 110 patients with relapsed osteosarcoma. *Five patients were long-term survivors in CR3, but one patient died of a cerebral aneurysm 18 years after diagnosis of osteosarcoma.

Figure 2

Median time from complete remission to subsequent relapse according to number of relapse in patients with relapsed osteosarcoma.

Figure 3

Post-relapse survival (PRS) and event-free survival (PREFS) for all 110 patients with relapsed osteosarcoma.

Figure 4

Post-relapse survival (PRS) distributions according to time to first relapse (A) and ability to achieve second complete remission (B) for all 110 patients with relapsed osteosarcoma, and according to laterality of relapse for patients with lung relapse only who achieved second complete remission (CR2) (C). Post-relapse event-free survival (PREFS) distributions according to chemotherapy use at first relapse for patients with relapsed osteosarcoma who did not achieve CR2 (D).