Researchers from Italy have reported that neoadjuvant chemotherapy improves prognosis and reduces amputations in patients over 40 years of age with localized osteosarcoma of the extremity. The details of this study appeared in the June, 2007 issue of Acta Orthopedica.

Osteosarcoma is predominantly a disease of adolescents and young adults. However, it does occur in older individuals. Increasing age has been assumed to be an adverse prognostic feature following treatment of osteosarcoma but data in the era of aggressive neoadjuvant chemotherapy are lacking. Osteosarcoma is currently treated by aggressive induction chemotherapy with ifosfamide, cisplatin and anthracycline regimens followed by limb sparing surgery or amputation and adjuvant chemotherapy. This approach results in a 50-70% five year disease-free survival in pediatric patients. 

Researchers from the Instituto Ortopedico Rizzoli in Bologna have reported outcomes of 34 patients aged 41 to 60 years treated between 1994 and 1999. Treatment consisted of 1 cycle of induction chemotherapy followed by surgery and then 3 further cycles of chemotherapy. Thirty patients had limb sparing surgery, 3 underwent amputation and 1 died of toxicity following the first course of chemotherapy. Nineteen patients have remained continuously disease-free and an additional 2 were rendered disease-free after a recurrence for an absolute disease-free survival of 62%. The 5-year event-free survival (EFS) was 56% and the overall survival (OS) was 70%. These authors stated that “These results are similar to those of 296 patients under 40 years of age who were treated with conventional chemotherapy (5-year EFS 59% and 5-year OS 70%), indicate that neoadjuvant chemotherapy improves prognosis and also reduces amputations in patients aged over 40 with osteosarcoma of the extremities.” 

Comments: These data suggest that older patients with osteosarcoma should be treated the same as younger patients for optimal results.

Reference:  Bacci G, Ferrari S, Mercuri M, et al. Neoadjuvant chemotherapy for osteosarcoma of the extremities in patients aged 41-60 years. Acta Orthopedica. 2007; 78:377-384.

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