Tumor size as prognostic factor in osteosarcomas

M G Pallotta, S Specterman, H Gioseffi, M E Lopez Lincuez, G Z Beguelin, J M Lastiri, M S Varela, M Makiya, E Dibar, D L Muscolo

Research output: Contribution to journalArticlepeer-review

Abstract

9061 Background: Multidisciplinary treatment of osteosarcoma has achieved overall survival greater than 70%. Several prognostic factors have been described. In our country it is frequent to diagnose voluminous tumors. Greater tumors usually have worst outcome because of greater chance of tumor resistance. In order to assess the relation between tumor size and prognosis in high-grade osteosarcoma, we performed the following analysis.

METHODS: Retrospectively, tumor volume was determined pre and post chemotherapy in 40 patients with histological diagnosis of high-grade osteosarcoma stage IIb. All of them received neo-adjuvant chemotherapy (ifosfamide + doxorrubicin + high dose methotrexate). Tumor size was determined in plain radiography (RX) (2 dimensions) and magnetic resonance imaging (MRI) (3 dimensions), according to RECIST criteria. Tumor calcifications, pathological fracture and skip metastasis were evaluated.

RESULTS: 22 men/18 women. Median age 17 years (range 11-47). Localizations: femur (25), tibia (9), fibula (3), humerus (2) and pelvis (1). Six patients presented pathological fracture and only one skip metastasis. 14 patients had systemic progression. Median survival was 96 months (IC 95%: 80-109) and median disease free survival was 84 months (IC 95%: 69-100). Tumor volume pre chemotherapy greater than >1500 cm3 (MRI) was the variable most predictor of mortality (p=0.02). Median survival was 48 months (IC 95%: 27-70) in tumors greater than 1500 cm3 versus 104 months (IC 95%: 91-118) in those tumors smaller than 1500cm3 (p=0.001). Intensification of radiological calcification, pathological fracture and changes in size pre and post chemotherapy did not have prognostic value.

CONCLUSIONS: tumor measurement at diagnosis can distinguish high-risk populations. MRI is superior to RX to estimate prognostic size value. MRI does not sub estimate soft parts of the tumor and allows delimiting better tumor margins. No significant financial relationships to disclose.

Original languageEnglish
Pages (from-to)9061
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology
Volume22
Issue number14_suppl
Publication statusPublished - 15 Jul 2004

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