Review of management issues in relapsed osteosarcoma

Abstract

Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. With combined modality treatment long-term survival rate for localized disease is near 70%. Thirty percent of patients relapse with lung as the commonest site. Surgery is the treatment of choice for relapsed patients whenever possible. Addition of chemotherapy to surgery provides survival benefit in patients not achieving second surgical remission. Even patients with multiple lung recurrences can be cured with repeated thoracotomies. Disease-free interval and complete surgical resection are the main prognostic factor for post-relapse survival.

Keywords::

• osteosarcoma
• relapse
• treatment

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• In osteosarcoma, one-third of patient with localized disease and two-third of patients with metastatic disease relapse after combined modality treatment.

• In the absence of surgical resection, cure is most often not achieved in relapsed osteosarcoma. Addition of chemotherapy to surgery is helpful for patients not achieving second surgical remission or as palliative intent in unresectable disease.

• Ifosfamide either alone or in combination with etoposide is the common combination chemotherapeutic agent used in many institutions.

• Complete surgical resection and disease-free interval >24–36 months are the main prognostic features for post-relapse survival.