The Journal of the Korean bone and joint tumor society (대한골관절종양학회지)

The Korean Musculoskeletal Tumor Society (대한근골격종양학회)
권호 표지
DOI QR코드

DOI QR Code

Effect of Preoperative Chemotherapy on Survival in High-grade Localized Osteosarcoma of the Extremity

골육종에서 수술 전 항암 약물치료가 생존에 미치는 영향

  • Choi, Eun-Seok (Department of Orthopaedic Surgery, Seoul National University College of Medicine) ;
  • Han, Ilkyu (Department of Orthopaedic Surgery, Seoul National University College of Medicine) ;
  • Cho, Hwan Seong (Department of Orthopaedic Surgery, Seoul National University College of Medicine) ;
  • Kim, Han-Soo (Department of Orthopaedic Surgery, Seoul National University College of Medicine)
  • 최은석 (서울대학교 의과대학 정형외과학교실) ;
  • 한일규 (서울대학교 의과대학 정형외과학교실) ;
  • 조환성 (서울대학교 의과대학 정형외과학교실) ;
  • 김한수 (서울대학교 의과대학 정형외과학교실)
  • Received : 2012.10.18
  • Accepted : 2012.11.12
  • Published : 2012.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Multidisciplinary approaches of surgical resection and chemotherapy have been widely used for the treatment of non-metastatic osteosarcomas. We aimed to assess the effect of neoadjuvant chemotherapy for metastasis and disease-specific survival. Materials and Methods: Authors retrospectively reviewed 225 young (<30 years old) and non-metastatic osteosarcoma patients who underwent surgical resection and postoperative chemotherapy between February 1984 and July 2010. Mean age was 14.4 years old (ranged: 4-29 years old) and average follow-up period was 9.1 years (2-28 years). The patients were divided into two groups according to the application of preoperative chemotherapy. Both groups were compared with clinical characteristics, metastasis-free survival and disease-specific survival. Results: All of 225 patients, 32 patients were treated with postoperative chemotherapy and 193 patients were performed preoperative and postoperative chemotherapy. Postoperative chemotherapy group showed significantly high rate of amputation (p<0.001). Metastasis was occurred in 101 patients. Postoperative chemotherapy group indicated significant higher rate of metastasis (69% vs 41%, p=0.004) and early development of metastasis (mean: 11.5 vs 20.3 months, p=0.045) than pre-and postoperative chemotherapy group. Fifty-seven patients were died of osteosarcoma. Postoperative chemotherapy group revealed significant lower rate of 5-year disease-specific survival than pre-and postoperative chemotherapy group (51% vs 84%, p=0.001). Adult (>15 years) and large sized tumor (>8 cm) were meaningful risk factors of metastasis and disease-specific survival. Although, local recurrences were occurred in 13 patients, there was no significant difference. Conclusion: Neoadjuvant chemotherapy offers better disease-specific survival and metastasis-free survival.

목적: 본 연구는 수술 전 항암 약물 치료가 전이가 없는 골육종 환자의 생존율과 전이에 미치는 영향에 대해 알아보고자 하였다. 대상 및 방법: 1984년부터 2010년까지 사지에 발생한, 전이가 없는 원발성 골육종으로 수술적 절제술과 수술 후 항암 약물 치료를 시행한 30세 미만의 환자 225명을 후향적으로 분석하였다. 평균 연령은 14.4세, 평균 추시기간은 9.1년이었다. 수술 후에만 항암 약물 치료를 시행한 군과 수술 전, 후 약물 치료를 시행했던 두군의 임상적 특성과 생존율을 비교하였다. 결과: 전체 225예 중 수술 후 약물 치료 군은 32예, 수술 전후 약물 치료 군은 193예였다. 수술 후 약물 치료 군은 절단 수술과(p<0.001), 전이의 빈도가 유의하게(p=0.004) 높았으며, 전이 발생시기도 빨랐다. 수술 후 약물 치료 군에서는 5년 생존율 51%로 수술 전후 약물 치료 군의 84%보다 낮았다(p=0.001). 국소재발은 유의한 차이가 없었다. 결론: 사지에 발생한 골육종 환자에서 수술 전 항암 약물 치료는 전이의 억제와 생존율 향상에 도움이 된다.

Keywords

References

  1. Ritter J, Bielack SS. Osteosarcoma. Ann Oncol. 2010;21 Suppl 7:vii320-5.
  2. Eilber F, Giuliano A, Eckardt J, Patterson K, Moseley S, Goodnight J. Adjuvant chemotherapy for osteosarcoma: a randomized prospective trial. J Clin Oncol. 1987;5:21-6.
  3. Goorin AM, Schwartzentruber DJ, Devidas M, et al; Pediatric Oncology Group. 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.
  4. Bielack SS, Machatschek JN, Flege S, Jürgens H. Delaying surgery with chemotherapy for osteosarcoma of the extremities. Expert Opin Pharmacother. 2004;5:1243-56.
  5. Arndt CA, Crist WM. Common musculoskeletal tumors of childhood and adolescence. N Engl J Med. 1999;341:342-52.
  6. Rosen G. Preoperative (neoadjuvant) chemotherapy for osteogenic sarcoma: a ten year experience. Orthopedics. 1985;8:659-64.
  7. Goldie JH. Scientific basis for adjuvant and primary (neoadjuvant) chemotherapy. Semin Oncol. 1987;14:1-7.
  8. Rosen G, Marcove RC, Caparros B, Nirenberg A, Kosloff C, Huvos AG. Primary osteogenic sarcoma: the rationale for preoperative chemotherapy and delayed surgery. Cancer. 1979;43:2163-77.
  9. Meyers PA, Heller G, Healey J, et al. Chemotherapy for nonmetastatic osteogenic sarcoma: the Memorial Sloan-Kettering experience. J Clin Oncol. 1992;10:5-15.
  10. Bielack SS, Kempf-Bielack B, Delling G, et al. 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.
  11. Bielack S, Jürgens H, Jundt G, et al. Osteosarcoma: the COSS experience. Cancer Treat Res. 2009;152:289-308.