Long-term results (>25 years) of a randomized, prospective clinical trial evaluating chemotherapy in patients with high-grade, operable osteosarcoma

被引:148
作者
Bernthal, Nicholas M. [2 ]
Federman, Noah [3 ]
Eilber, Frederick R. [4 ]
Nelson, Scott D. [5 ]
Eckardt, Jeffrey J. [2 ]
Eilber, Fritz C. [4 ]
Tap, William D. [1 ]
机构
[1] Mem Sloan Kettering Canc Ctr, Dept Med, Div Solid Tumors, Melanoma & Sarcoma Serv, New York, NY 10065 USA
[2] Univ Calif Los Angeles, David Geffen Sch Med, UCLA Orthoped Hosp, Dept Orthoped, Los Angeles, CA 90095 USA
[3] Univ Calif Los Angeles, UCLA Jonsson Comprehens Canc Ctr, Dept Pediat Hematol Oncol, Los Angeles, CA USA
[4] Univ Calif Los Angeles, Div Surg Oncol, Los Angeles, CA USA
[5] Univ Calif Los Angeles, Dept Pathol, Los Angeles, CA USA
关键词
osteosarcoma; chemotherapy; randomized trial; long-term follow-up; ADJUVANT CHEMOTHERAPY; SURVIVAL; SARCOMA; PREDICTOR; EXTREMITY; SURGERY; THERAPY;
D O I
10.1002/cncr.27651
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
BACKGROUND: The authors present the long-term follow-up (>25 years) data from 1 of the original prospective, randomized trials that compared adjuvant chemotherapy with expectant management in patients with high-grade, localized osteosarcoma. In addition, the value of pathologic necrosis induced by a single cycle of neoadjuvant chemotherapy was analyzed as a predictive marker of disease-free and overall survival. METHODS: Fifty-nine patients with high-grade, localized osteosarcoma were enrolled in a prospective trial that was performed between 1981 and 1984 at the University of California-Los Angeles (UCLA). Patients were randomized to receive either adjuvant chemotherapy or observation after surgical resection. Long-term outcomes, follow-up, and pathologic review of all available histologic sections were performed. RESULTS: The 25-year disease-free survival rate was 28% for patients who received adjuvant chemotherapy compared with 15% for the untreated patients (P = .02). The overall survival rate at 25 years was also significantly higher for treated patients versus untreated patients (38% vs 15%; P = .02). Tumor necrosis >90% after a single round of chemotherapy was a statistically significant predictor of overall survival and disease-free survival for patients who received adjuvant therapy (164 months vs 65 months [P = .04] and 141 months vs 14 months [P < .01], respectively). CONCLUSIONS: Patients with high-grade, localized osteosarcoma who received adjuvant chemotherapy after undergoing definitive surgical resection had a statistically significant benefit in disease-free and overall survival that was maintained through 25 years. Tumor necrosis after just 1 cycle of neoadjuvant chemotherapy and radiation was predictive of overall survival and disease-free survival in patients who received adjuvant chemotherapy. Cancer 2012. (c) 2012 American Cancer Society.
引用
收藏
页码:5888 / 5893
页数:6
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