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Survival of pediatric patients after relapsed osteosarcoma: The St. Jude Children's Research Hospital experience

Leary, Sarah E. S. ; Wozniak, Amy W. ; Billups, Catherine A. ; Wu, Jianrong ; McPherson, Valerie ; Neel, Michael D. ; Rao, Bhaskar N. ; Daw, Najat C.

Cancer, 2013-07, Vol.119 (14), p.2645-2653 [Periódico revisado por pares]

Hoboken, NJ: Wiley-Blackwell

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Título:
Survival of pediatric patients after relapsed osteosarcoma: The St. Jude Children's Research Hospital experience
Autor: Leary, Sarah E. S. ; Wozniak, Amy W. ; Billups, Catherine A. ; Wu, Jianrong ; McPherson, Valerie ; Neel, Michael D. ; Rao, Bhaskar N. ; Daw, Najat C.
Assuntos: Adolescent ; Adult ; Biological and medical sciences ; Bone Neoplasms - mortality ; Bone Neoplasms - pathology ; chemotherapy ; Child ; Child, Preschool ; Cohort Studies ; Disease-Free Survival ; Diseases of the osteoarticular system ; Female ; Hospitals, Pediatric - statistics & numerical data ; Humans ; Kaplan-Meier Estimate ; Male ; Medical Records ; Medical sciences ; Multiple tumors. Solid tumors. Tumors in childhood (general aspects) ; Neoplasm Grading ; osteosarcoma ; Osteosarcoma - mortality ; Osteosarcoma - pathology ; outcome ; prognostic factors ; Recurrence ; relapse ; Retrospective Studies ; Sex Distribution ; survival ; Tennessee - epidemiology ; Tumors ; Tumors of striated muscle and skeleton ; Young Adult
É parte de: Cancer, 2013-07, Vol.119 (14), p.2645-2653
Notas: Sarah E. S. Leary's current affiliations: Division of Pediatric Hematology/Oncology, Seattle Children's Hospital, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington. Najat C. Daw's current affiliation: Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Dr. Leary is currently a member of the Division of Hematology/Oncology, Seattle Children’s, Seattle, WA; and Dr. Daw is currently a member of the Division of Pediatrics, MD Anderson Cancer Center, Houston, TX.
Descrição: BACKGROUND Chemotherapy has improved the outcome of patients with newly diagnosed osteosarcoma, but its role in relapsed disease is unclear. METHODS We reviewed the records of all patients who were treated for relapsed high‐grade osteosarcoma at our institution between 1970 and 2004. Postrelapse event‐free survival (PREFS) and postrelapse survival (PRS) were estimated, and outcome comparisons were made using an exact log‐rank test. RESULTS The 10‐year PREFS and PRS of the 110 patients were 11.8% ± 3.5% and 17.0% ± 4.3%, respectively. Metastasis at initial diagnosis (14%), and relapse in lung only (75%) were not significantly associated with PREFS or PRS. Time from initial diagnosis to first relapse (RL1) ≥18 months (43%), surgery at RL1 (76%), and ability to achieve second complete remission (CR2, 56%) were favorably associated with PREFS and PRS (P ≤ 0.0002). In patients without CR2, chemotherapy at RL1 was favorably associated with PREFS (P = 0.01) but not with PRS. In patients with lung relapse only, unilateral relapse and number of nodules ( ≤ 3) were associated with better PREFS and PRS (P ≤ 0.0005); no patients with bilateral relapse survived 10 years. The median PREFS after treatment with cisplatin, doxorubicin, methotrexate, and ifosfamide was 3.5 months (95% confidence interval, 2.1‐5.2), and the median PRS was 8.2 months (95% confidence interval, 5.2‐15.1). CONCLUSIONS Late relapse, surgical resection, and unilateral involvement (in lung relapse only) favorably impact outcome after relapse. Surgery is essential for survival; chemotherapy may slow disease progression in patients without CR2. These data are useful for designing clinical trials that evaluate novel agents. Cancer 2013;119:2645‐2653. © 2013 American Cancer Society. Patients with relapsed osteosarcoma have a poor prognosis. Whereas surgery is essential for survival, chemotherapy may slow disease progression in patients without remission. This study provides data on prognostic factors and event‐free survival after relapse that are needed for the design of phase 2 trials of novel agents.
Editor: Hoboken, NJ: Wiley-Blackwell
Idioma: Inglês

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Survival of pediatric patients after relapsed osteosarcoma: The St. Jude Children's Research Hospital experience

Leary, Sarah E. S. ; Wozniak, Amy W. ; Billups, Catherine A. ; Wu, Jianrong ; McPherson, Valerie ; Neel, Michael D. ; Rao, Bhaskar N. ; Daw, Najat C.

Hoboken, NJ: Wiley-Blackwell

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