Archive for the ‘Age and osteosarcoma’ Category

At 5 years old, Jasmine Williams is fighting rare cancer

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Posted 22 Oct 2011 — by James Street
Category Age and osteosarcoma, Bone repair, Cost, Finance and Politics of cancer research and treatment, Osteosarcoma

Published: Friday, October 21, 2011

By Caitlin Fertal
CFertal@News-Herald.com

Just prior to four months ago, 5-year-old Jasmine Williams was as healthy as could be.

Her parents Dixie and Michael Williams of Chardon never had to worry about her getting sick; she was even described as “freakishly healthy.”

It was her 8-year-old brother Anthony who typically caught colds — but that all changed in July.

Jasmine was taken to the hospital when her mom discovered that she may have had an abscessed tooth. Upon examination, doctors told the family to head to University Hospitals Rainbow Babies Children’s Hospital right away.

Cancer was the diagnosis.

Originally, doctors thought that the then 4-year-old had rhabdomyosarcoma, a cancer that affects connective tissues such as muscle, fat, membranes that line the joints or blood vessels.

While a devastating diagnosis, it was only about to get worse.

The family soon was told that Jasmine actually had a rare, more aggressive form of cancer — osteosarcoma.

While osteosarcoma itself is the most common type of cancer that starts in the bone, the exact type that Jasmine has is something that her doctors are not familiar with, Dixie Williams said.

Typically this cancer affects the arm or leg bones, however, for Jasmine it started near her jaw, which can lead to a less favorable outcome, according to The American Cancer Society.

Jasmine has already undergone an extensive, 13-hour surgery to remove a large tumor from her jaw area, as well as daily chemotherapy treatment.

Her mother explained the surgery:

“(They) removed all of her baby and adult teeth in the left upper jaw, all the bone is gone; the cheek bone is gone, part of the orbit of her eye is gone — and part of her nasal on the left side, the whole left roof or her mouth and everything. They took a graft and cut from her knee to her hip and reconstructed that side of her face with all soft tissue because she’s still growing.”

She is currently receiving three different types of chemotherapy, which kill every rapidly growing cell in the body. This type of treatment has unpleasant side effects, but aggressively goes after cancer cells.

Due to the treatments, only the fine, baby hair that lines Jasmine’s head remains, which her mother said was probably the hardest part for the little girl.

“She had really long hair that she loved.”

The therapy also makes Jasmine nauseous and at times, she completely loses her appetite. She has a feeding tube that her parents will use when she refuses to eat, her mother said.

“It enables us to give her the nutrients and stuff that she needs when she won’t eat because there are times when she won’t,” she said. “Originally they put it in because of the procedure, she had so much swelling and they had done so much work they didn’t want to jeopardize their grafts with all the sutures.”

The family spends about 20 days per month in the hospital in order for Jasmine to keep up with all of her chemotherapy as well as the eight to 10 different prescriptions she needs.

As can be imagined, the family’s medical expenses have totalled close to $750,000 so far.

Dixie left her job as at University Hospitals Geauga Medical Center temporarily in the very beginning, and Michael stopped work completely in order to care for their daughter.

Anthony was pulled out of school and now often learns in between happenings at the hospital.

The first week in November she will undergo additional cat scans. If no regrowth is found, then they will continue the schedule of chemotherapy that Jasmine is currently on. The same process will occur in February, and if there is still no regrowth, Jasmine will be considered in remission.

“But the chemo — there’s always a risk of developing another type of cancer like leukemia,” Dixie Williams said. “It’s cancer, so it’s never over.”

A concern for the family is that the cancer could easily spread or metastasize to other organs or bone tissue.

“I think the hardest thing for us is that there’s no statistics. There’s no set way to treat it because they’ve never seen it before,” Dixie Williams said. “It’s something we just take day by day because the overall picture is just too much to bare.”

A family member partnered with the fund raising website GiveForward in an effort to help alleviate the financial burden on the Williams family.

To see pictures of Jasmine, or to donate, visit www.giveforward.com/jasminesjourney.

The Beat Goes On

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Posted 18 Oct 2011 — by James Street
Category Age and osteosarcoma, Life Death and Dying, Osteosarcoma
Monday, October 17th, 2011 at 10:00 am  |  2 responses

A Q&A with the filmmaker of a new documentary on the late, great Wayman Tisdale.

by Jonathan Santiago / @itsJONsantiago

Wayman Tisdale passed away in 2009 after a two-year battle with a rare form of bone cancer.  Now his life’s story is being told in a documentary that features interviews with some of Tisdale’s closet contemporaries in music and basketball.

The Wayman Tisdale Story was written, produced and directed by Emmy-nominated filmmaker Brian Schodorf.  He was inspired to make the film after hearing of Tisdale’s fight with osteosarcoma. Following  dozens of emails, letters and numerous phone calls to those in Tisdale’s circle, Schodorf finally broke through in 2009 when he connected with the former basketball star.  He went on to capture what would be some of Tisdale’s final days, including the self-taught musician’s last jazz tour.

“He would never let anyone know that (his illiness) was more serious than he led them to believe,” Schodorf said of Tisdale.  “Because he didn’t want anybody to feel sorry for him. “

Schodorf never expected the film’s production to take as long as it did.  But because of budget constraints, the documentary took two-and-a-half years to make.

“Every time we’d watch it, Wayman lit up the screen and we knew people had to see this (film),” Schodorf said, recalling the many days he worked on the film essentially for free in a cold Chicago apartment from 2009 to 2011.  “But there were a lot of days when I was like, ‘ This is never going to get done.’”

Fortunately Tisdale’s record label, Mack Avenue Records along with ESPN and NBA TV came along and injected life into the project, which is set to air next month.

SLAM: What compelled you to make a documentary about Wayman?

Brian Schodorf: I get that question a lot.  And it’s interesting because I really didn’t know that much about him.  I really wasn’t a jazz guy.  I didn’t follow his career.  I remember he had been in the NBA and he was a pretty good player.  But when I saw a little bit about what he was going through with his leg, I just felt like that’s a story I had to tell, and I just had to do it.

So, I got an investor and I ended up going down to Tulsa and I pitched Wayman on the idea.  And it’s hard when you are coming from the outside to try and come in and get in a public figure’s life to do a documentary.  But you know, Wayman was one of those guys who was so open.  He was so touchable.  People always say, “I met him he was so cool.  He didn’t seem like an NBA player” because he really wasn’t.  He was just a regular guy.  For me, if my leg had just been amputated and I was going through this struggle and this battle, I probably wouldn’t want to talk to anybody.  But that just kind of shows his character and what type of guy he was.

SLAM: Is this your first biographical documentary?

BS: It is.  It’s the first biography I’ve done and it was a challenge.  I think in the history of my life – I’m not going to say in the history of the world – but in the history my life, I’ve never came across a more flawless person with the coolest life.  I mean the guy lived 44 years.  He had nine records – many of them went number one.  He played 12 years in the NBA.   He was a three time All-American.  He was (an Olympic) gold medalist.  And there wasn’t any one person who had anything bad to say about him.  Going from Michael Jordan to Toby Keith – and that’s a pretty tough crowd to impress [laughs].  Those guys aren’t known for their complimentary attitudes toward other people and he just won everybody over.  Making a documentary about somebody like that was definitely challenging.

But at the end of the day, we didn’t have a lot of material to work with because he passed away less than a week after our last interview with him.  We had two or three interviews that we did.  And then we had to go around and look for archival footage and different materials to put it together.  Since he had just passed away, it made it a little bit more difficult.  But I think we got it done.  I think it definitely gives justice to his name.

SLAM: When you told him that you wanted to make a documentary about him, what were his initial thoughts on the project?

BS: He was very, very excited about it.  But (in the beginning) you’re really just kind of feeling the process out.  A guy like Wayman, being in Los Angeles, Sacramento and Phoenix, had a lot of people approaching (him) that wanted different things.  Initially, you have to work through some of those trust issues, especially being a stranger.

(But) he was excited about it.  He wanted to do it.  We had some good ideas about it.  But we were still in the initial phases of trying to feel it out, see what it could be and getting to know each other.  We never really ended up getting to the point where we were working on it together.  I mean, he passed away so quickly – it was literally a week after.  So we were going to hook back up, but unfortunately there wasn’t enough time.

SLAM: How did his passing affect the production process of the film?

BS: As far as the production, it’s tough to say because had he still been alive, had he beat his battle, would we have gone out and interviewed Michael Jordan and all these other guys?  Maybe.  Maybe we might have just stayed with Wayman and had him tell the whole story.  I think it probably sped things up, because knew what we had to work with.

We started shooting in 2009 and a lot of stuff that you see in 2007, 2008 and early 2009 – a lot of that is stock footage and archived materials.  I think his death probably did speed things up.  We were hoping to get it out sooner.  But we were working with the NBA, the NCAA, ESPN  – all these different groups -  and we were working with the Tisdale family.   We wanted to make sure we got things right for them and gave them proper time to deal with everything.

SLAM: The film is primarily told in Wayman’s own words.  Talk about the style you chose to tell his story.

BS: We started off (telling the story) from birth until death, chronologically,  and we just said “this doesn’t have it.” It was missing that tension, that kind of push, pull (with the audience).  So that’s why we (told it) through some flashbacks.  We just wanted to keep audiences engaged through that process and we didn’t want it to all be about the cancer too.  That’s another reason why we did not get into the medical things about what was going on inside his leg, about the osteosacroma cancer.

Very rarely does a grown man, for that matter a 6’10 former professional athlete develop this disease.  It’s one-in-a-million for somebody like Wayman Tisdale to develop this disease.  But at the request of his family and kind of the way I saw this whole thing playing out, I didn’t want to make this a cancer movie.  I didn’t want to make this about cancer because that’s not what we wanted to remember Wayman by and that’s not how we wanted everybody to see him.

SLAM: Michael Jordan, country singer Toby Keith and a couple other others from the worlds of music and basketball are featured in the film.  Why did you reach out to those people in particular?

BS: I wish I could have gotten some more.  I had no budget for this thing literally, but I wanted to get Charles Barkley (and) I wanted to get Jamie Foxx – obviously because Charles Barkley played with him on the Suns.  Jamie Foxx was a good friend (of Wayman’s).  Larry Bird, I was trying to get him.  I was trying to get Magic Johnson.  Those are the four guys that I wanted and I wasn’t able to get.

For Michael Jordan, the PR person with the Bobcats told me he gets 300 interview requests a day.  Not a week.  Not a month.  A day. [laughs]  That just shows you how rarely he does interviews.  But once he saw Wayman Tisdale’s name, he said “I’ll do that one”.  Michael Jordan was an obvious choice because they played on the Olympic team together.  They were really good friends.  Michael Jordan was (also) a big fan of his music.

Sam Perkins (also in the film) was the best man at his wedding – they were best friends.  And AC Green played with him on the Suns and they were very close.  They were both Christians and had a lot of that in common.

SLAM: From the music world, fellow jazz musicians Dave Koz, Marcus Miller and Jonathan Butler were also interviewed.

BS: I was going back to how much (Wayman) fit into his life.  These guys are top notch musicians – top of the game, best in the world.  He transitioned from his basketball friends over here to these music guys and they all became very close.  You could’ve picked a hundred other people that were well-known with admiration and stories about what type of guy Wayman was.

SLAM: What do you want people who watch your film to take away from Wayman’s story?

BS: I think the point of the documentary is its message on how you live life.  And I think you can summarize it pretty easily from the life Wayman led.  You treat people kindly, you have faith in your life and in your spirituality and you have respect for your wife and your children.  You try to fit as much in as possible and utilize your talents to the fullest. And in the end you die with courage, knowing that you’re going to a better place because of the life you’ve lived here on earth.

When you see Wayman on his last leg there, he didn’t complain.  It kind of makes us look silly complaining about problems looking at how Wayman dealt with his.  So (in the end), it should uplift people and lead them to a better way of living.

NBA TV will air The Wayman Tisdale Story on November 10th, with an ESPN broadcast to follow on a still-to-be-determined date.  If you’re in the Sacramento area, the Kings will have a special screening of the film this Wednesday night, October 19th at Power Balance Pavilion.  For more information, visit Kings.com.

Clinical characteristics and prognosis of osteosarcoma in young children under five: a retrospective series of 15 cases

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Posted 25 Sep 2011 — by James Street
Category Age and osteosarcoma, Artificial Knees and implants, Artificial limbs, Osteosarcoma, Osteosarcoma Outcomes

Osteosarcoma is the most common primary bone malignancy in childhood and adolescence. However, it is very rare in children under 5 years of age.

Although studies in young children are limited in number, they all underline the high rate of amputation in this population, with conflicting results being recently reported regarding their prognosis.

Methods: To enhance knowledge on the clinical characteristics and prognosis of osteosarcoma in young children, we reviewed the medical records and histology of all children diagnosed with osteosarcoma before the age of five years and treated in SFCE (Societe Francaise des Cancers et leucemies de l’Enfant) centers between 1980 and 2007.

Results: Fifteen patients from 7 centers were studied. Long bones were involved in 14 cases.

Metastases were present at diagnosis in 40% of cases. The histologic type was osteoblastic in 74% of cases.

Two patients had a relevant history. One child developed a second malignancy 13 years after osteosarcoma diagnosis.Thirteen children received preoperative chemotherapy including high-dose methotrexate, but only 36% had a good histologic response.

Chemotherapy was well tolerated, apart from a case of severe late convulsive encephalopathy in a one-year-old infant. Limb salvage surgery was performed in six cases, with frequent mechanical and infectious complications and variable functional outcomes.Complete remission was obtained in 12 children, six of whom relapsed.

With a median follow-up of 5 years, six patients were alive in remission, seven died of their disease (45%), in a broad range of 2 months to 8 years after diagnosis, two were lost to follow-up.

Conclusions: Osteosarcoma seems to be more aggressive in children under five years of age, and surgical management remains a challange.

Author: Maud GuillonPierre MaryLaurence BrugierePerrine Marec-BerardHelene PacquementClaudine SchmittJean-Marc GuinebretiereMarie-Dominique Tabone
Credits/Source: BMC Cancer 2011, 11:407

A Childhood Cancer is Different from Adult Cancers

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Posted 08 Jan 2011 — by James Street
Category Age and osteosarcoma, Etiology and cause of osteosarcoma, genetic research, genetic research, Stem Cell Research, Understanding Cancer

Far Fewer Mutations

Saturday, January 8, 2011
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Earlier in mid-December, a study was published reporting that a cancer in children is very different from cancers in adults. Specifically, the study suggests that there are far fewer mutations present in some childhood cancerous tumors than in tumors of adult cancers. This could have significant implications for not only how we approach and treat childhood cancers, but how we treat combat cancers in general.

The study, which was published in the journal Science, was a large collaborative effort involving 20 different medical institutes, cancer centers, and universities in the U.S. that looked at the genetics of a very aggressive brain cancer found primarily in children called medulloblastoma. Although medulloblastoma tumors originate in a certain area of the brain, the cancer can spread through the spinal fluid to other parts of the central nervous system (which includes the brain and spinal cord). Every year, about 1 in 200,000 children under the age of 15 are diagnosed with having medulloblastoma, and although therapies to treat them have improved, still many cannot be cured and often there are severe side-effects from the therapies. It’s a devastating cancer. Medulloblastoma is very rare in people over 40, which most likely has to do with how medulloblastoma comes to be.

Researchers have recently found that childhood medulloblastomas have many fewer mutations than different adult cancers.

Click to enlarge photo

Researchers have recently found that childhood medulloblastomas have many fewer mutations than different adult cancers.

Although its identity has been hotly debated in recent years, it’s now thought that medulloblastoma is created from cells that were primitive neural stem cells. Such neural stem cells are normally present during fetal development, but in patients with medulloblastoma, these stem cells have mutations in their DNA that led to the formation of a highly malignant tumor.

The study To test whether, and how, medulloblastoma in children is different from adult cancers, the researchers looked at the DNA from 22 different medulloblastoma samples from children as well as DNA from several different adult cancers (including pancreatic, glioblastoma, colorectal, and breast cancer tumors). The DNA sequences of all known genes were analyzed both in tumors and in normal, non-cancerous tissues taken from the same patients. In this way, the scientists could determine which genes were different, or mutated, in the tumors compared to healthy tissue. This is commonly done when studying cancer, and identifying which genes are mutated helps us better understand what causes cancer.

Far fewer mutations in a childhood cancer than adult cancers Interestingly, the scientists found that the medulloblastoma tumors in children had about five to ten times fewer mutated genes than several different adult tumors studied (which were not medulloblastomas). However, while the childhood tumors had many fewer mutations, over one third were mutations known to disrupt gene function, which is a much higher percentage than in the adult tumors analyzed. This may simply be because the adult cancers are in older tissues, and these tissues have had a longer opportunity to gain random mutations over time, but it’s difficult to tell. Either way, this shows that childhood cancer is very different from adult cancers.

The likely suspects How can we use our knowledge of these differences between childhood and adult cancers to help us better combat cancer? To answer this question, it’s important to look at exactly what the researchers found, which comes down to some very specific genes that probably play central roles in causing cancer.

Some of the genes commonly mutated in the medulloblastoma tumors belong to two different groups of well-studied genes, the Hedgehog and Wnt gene groups. (Many genes have somewhat whimsical names, mostly due to early studies in fruit flies; the Hedgehog genes, for example, don’t have anything to do with the hedgehog animal.) These groups of genes are thought to primarily function during embryonic development and during some cancers. Specifically, the mutation of some Hedgehog and Wnt genes has previously been shown to correlate with the occurrence of different cancers, including medulloblastoma.

This recent study not only confirmed previous studies linking Hedgehog and Wnt genes to medulloblastoma, but the researchers also discovered that other genes, including ones not previously suspected, may also be involved in causing medulloblastoma. These newly suspected genes belong to the histone-lysine N-methyltransferase gene family, whose members actually control whether many other genes are active or not. Consequently, by having mutations in these identified genes (which are specifically the histone-lysine N-methyltransferase genes MLL2 and MLL3), the tumors have changed the function of many other genes, causing a kind of snowball effect.

The researchers found that MLL2 or MLL3 were mutated and consequently no longer active in 16 percent of the medulloblastoma tumors they looked at. This suggests that MLL2 and MLL3 normally play important roles in preventing the occurrence of medulloblastoma—that they are what are called “tumor suppressor genes”. Additionally, it’s known that these genes are also very important during normal brain development, which again emphasizes how this childhood cancer is different from adult cancers; the childhood cancer is almost certainly the result of something going wrong during development.

Contributing to how we view cancer While the most significant finding in this study was how many fewer mutations are present in a primarily childhood cancer, medulloblastoma, compared to adult cancers, understanding the specific genes revealed to be key to causing medulloblastoma will not only change how we view and treat childhood cancer, but will also help us better understand which genes are key players in causing cancer in general. It’s becoming clearer that childhood cancer, as shown here with medulloblastoma, is due to problems that manifest during fetal development.

Additionally, the family of genes that MLL2 and MLL3 belong to has already been suspected of being involved in the occurrence of many other types of cancer, and this most recent finding with medulloblastoma warrants further investigation of this gene family and its connections to cancer.

Lastly, because this childhood cancer has many fewer mutated genes than adult cancers, it gives researchers a few genes to really focus on; the genes mutated in medulloblastomas may be the few, most essential genes responsible for this kind of cancer and most likely other cancers. Although applying these findings to other cancers may be difficult; in this study, childhood medulloblastomas were not compared to adult medulloblastomas (which are very rare, but may reveal additional differences), and clearly this study has shown that not all cancers are alike.

Fighting cancer with gene therapy To date, over 80 cancers have had all of their known genes analyzed for apparent mutations. As we better understand which genes are most important for causing, and preventing, cancer, researchers can not only develop better methods for identifying the type of cancer a patient has, but can also develop better therapies to target these specific genes. For example, in medulloblastoma, thanks to this recent study, the development of drugs that target the genes MLL2 and MLL3 is a very appealing prospect, but a better understanding of these genes (and improvements in gene therapies in general) is needed before such therapies can become a reality.

For more on medulloblastoma and recent comparisons of this childhood cancer to adult cancers, see the original article published in the journal Science in December 2010, read coverage of this article by The Scientist, or see Wikipedia’s article “Medulloblastoma.”

Biology Bytes author Teisha Rowland is a science writer, blogger at All Things Stem Cell, and graduate student in molecular, cellular, and developmental biology at UCSB, where she studies stem cells. Send any ideas for future columns to her at science@independent.com

Disease Stage Not Patient Age Predicts 1-year Survival After Chemotherapy: Presented at ASCO

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Posted 12 Aug 2010 — by James Street
Category Age and osteosarcoma

By Bruce Sylvester

ATLANTA, G.A. — June 8, 2006 — A retrospective study of data on a diverse group of cancer elderly patients who had undergone chemotherapy showed that these patients achieved 1-year survival outcomes comparable to those of a younger patient population, suggesting that the such treatment is beneficial for the elderly.

The findings were presented here on June 3rd at the American Society of Clinical Oncology 2006 Annual Meeting (ASCO).

“About 3% of the patients who received systemic chemotherapy at our cancer center during the 4-year period in the study were 80 or older,” said lead investigator Peter Jiang, MD, research oncologist, Karmonos Cancer Institute, Wayne State University, Detroit, Michigan. “We studied them because the data is limited about chemotherapy in this age group, a group that is growing in numbers.”

The investigators performed a retrospective identification of patients who had received systemic chemotherapy at the Karmonos Cancer Center between January 1, 2000, and December 31, 2004. The study enrolled patients with a diagnosis of cancer who were older than 80 years. Patients who received only supportive care, hormonal therapy, or oral chemotherapy were excluded.

The investigators analyzed data on 133 subjects who received chemotherapy. The median age was 83, and 31% of the patients were > 85 years; 61% were female. Racial distribution was: whites 65 (49%), African-Americans 41 (31%), Others 18 (13%), Unknown 9 (7%).

The researchers reported that 16% of the patients were diagnosed with hematologic malignancy and 84% with solid tumors. Gynecological cancers (32%) were the most common solid tumors, followed by aerodigestive cancers (26%). Subjects with solid tumor showed regional (48%) or distant (45%) disease.

During the first chemotherapy regimen, subjects received 512 cycles of chemotherapy, with a median of 3 cycles per patient (range 1-24 cycles). The researchers noted that 40% of the subjects received only 2 cycles of chemotherapy, and 64% of all of the subjects were able to receive chemotherapy without second-cycle delay.

The distribution of single or multi-drug regimens was fairly similar, with solid tumor patients receiving 52% versus 48%, respectively, and hematologic cancer subjects receiving 43% versus 57%, respectively.

Among the solid tumor patients, carboplatin-plus-paclitaxel (22%) was the most common regimen. And 26% of all patients received a second regimen.

The investigators reported that the 1-year survival rates for hematologic cancer and solid tumor patients were 65% and 48%, respectively. Stage of disease, not age, was the only significant factor predicting survival.

“We found survival rates that were comparable to outcomes typical of these tumor types in other adults, regardless of age,” said Dr. Jiang. “This means that chemotherapy can promote survivability in people over 80 and should be considered seriously. This will become increasingly important as the US population ages.”

Age and Other Factors Influence Osteosarcoma Outcomes

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Posted 11 Aug 2010 — by James Street
Category Age and osteosarcoma, Chemotherapy, Follow up Treatment, Osteosarcoma Outcomes

By Will Boggs, MD

NEW YORK MAR 30, 2006 (Reuters Health) – Age, alkaline phosphatase level, tumor volume,
and other factors influence the outcomes for osteosarcoma of the extremity treated with
neoadjuvant chemotherapy, according to a report by Italian investigators published in the March
1st issue of Cancer.

Optimal treatment is neoadjuvant chemotherapy, Dr. Gaetano Bacci from Istituto Ortopedico
Rizzoli, Bologna, told Reuters Health. “However in some cases (about 10%) with small tumor,
especially if located in expendable bones (for instance, fibula), immediate surgery followed by
chemotherapy could be better.”

Dr. Bacci and colleagues evaluated the influence of several patient- and treatment-related
prognostic factors in a series of 789 patients with nonmetastatic osteosarcoma of the extremities
treated with neoadjuvant chemotherapy and followed for at least 5 years.

After a follow-up ranging from 5 to 22 years, more than half the patients (n=440) remained
continuously event-free, the authors report. Another 313 had a recurrence, 20 developed a
second neoplasm, and 10 patients died.

Age of 14 years or younger, elevated serum alkaline phosphatase at presentation, tumor volume
200 mL or more, inadequate surgical margins, and poor histologic response to preoperative
chemotherapy each independently predicted a high risk of recurrence, the results indicate.

The first recurrences were isolated lung metastases in 243 patients (77.6%), isolated bone
metastases in 26 patients (8.3%), combined lung and bone metastases in 5 patients (1.6%), and
other sites in 3 patients (0.9%), the researchers note. The average time to recurrence was 24.5
months.

Among 313 patients who relapsed, 171 (54.6%) were treated with surgery alone, 43 (13.7%)
received surgery plus a second-line chemotherapy, 24 (7.7%) received chemotherapy only, and 6
(1.9%) received radiotherapy. Nearly two thirds of patients treated for the first recurrence entered
remission.

Overall, after a median of 8 years follow-up, 19.8% of patients who relapsed were alive and
disease-free after the last treatment for systemic recurrence, the investigators report. Another 5
patients were alive with uncontrolled disease, and 246 relapsed patients had died.

When the surgical margins are inadequate, 30% of patients experience local recurrence in spite of
chemotherapy, Dr. Bacci said. “Local recurrence in osteosarcoma is a dramatic event because it
is almost always associated with systemic relapse. The post-relapse outcome of patients who
experience local recurrence is worse than the outcome of patients who relapse with only lung
metastases.”

For this reason, patients with osteosarcoma should be surgically treated in very selected centers
with a vast experience in the treatment of bone tumors, Dr. Bacci concluded.

SOURCE:

* Cancer 2006;106:1154-1161.