The pelvis is an infrequent site of osteosarcoma and treatment requires surgery plus systemic chemotherapy. Poor survival has been reported, but has not been confirmed previously by the Children's Oncology Group (COG). In addition, survival of patients with pelvic osteosarcomas has not been compared directly with that of patients with nonpelvic disease treated on the same clinical trials.

Questions/purposes

First, we assessed the event-free (EFS) and overall survival (OS) of patients with pelvic osteosarcoma treated on COG clinical trials. We then asked whether patient survival compared with that of patients treated on the same clinical trials with nonpelvic disease. Finally, we asked whether patients with metastatic disease at initial diagnosis had worse survival.

Methods

We retrospectively reviewed data from 1054 patients with osteosarcoma treated in four studies between 1993 and 2005. Twenty-six of the 1054 patients (2.5%) had a primary tumor of the pelvis. At diagnosis, nine patients had metastatic disease. The minimum followup was 2 months (mean, 34 months range, 2--102 months).

Results

Two of the nine patients with metastatic disease at diagnosis and five of the 17 with localized disease were alive at last contact. Estimates of the 5-year EFS for localized versus metastatic disease of the pelvis were 22% versus 23%. OS for patients with localized versus metastatic disease was 47% versus 22%. Patients with osteosarcoma in all other locations had a 5-year EFS of 57% and OS of 69%.

Conclusions

Our analysis confirms poor survival for patients with pelvic osteosarcoma. Survival with metastatic disease in the absence of a pelvic primary tumor is similar to that for localized or metastatic pelvic osteosarcoma. Improved surgical or medical therapy is needed, and patients with pelvic osteosarcoma may warrant alternate or experimental therapy.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Author Affiliation:

(1) Department of Hematology-Oncology, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA

(2) Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

(3) Department of Pediatric Hematology-Oncology, Massachusetts General Hospital, Boston, MA, USA

(4) Department of Orthopedic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

(5) Division of Sarcoma, H. Lee Moffitt Cancer Center, Tampa, FL, USA

Article History:

Registration Date: 01/02/2012

Received Date: 19/08/2011

Accepted Date: 01/02/2012

Online Date: 22/02/2012

Article note:

This research was supported by the Chair's Grant U10 CA98543 and Human Specimen Banking Grant U24 CA114766 of the Children's Oncology Group from the National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. Additional support for research is provided by a grant from the WWWW (QuadW) Foundation, Inc ( www.QuadW.org) to the Children's Oncology Group.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

 
Source Citation
Barkauskas, Donald A., et al. "Poor Survival for Osteosarcoma of the Pelvis: A Report from the Children's Oncology Group." Clinical Orthopaedics and Related Research® 470.7 (2012): 2007+. Health Reference Center Academic. Web. 11 June 2012.
Document URL
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