Tumor size as a predictor of outcome in pediatric non-metastatic osteosarcoma of the extremity

Division of Diagnostic Imaging , St. Jude Children's Research Hospital, Memphis, Tennessee, United States
Pediatric Blood & Cancer (Impact Factor: 2.39). 12/2004; 43(7):723-8. DOI: 10.1002/pbc.20077
Source: PubMed


Better predictors of outcome would allow improved risk-adapted therapy for pediatric nonmetastatic osteosarcoma of the extremity. We investigated the predictive value of MR imaging-based measures of absolute and relative tumor size and volume at the time of diagnosis. We also assessed the relation of tumor size to age and histologic response.
We retrospectively abstracted demographic, treatment history, and outcome information of patients treated on a single institutional protocol. A single pediatric oncologic radiologist manually measured each primary lesion and the affected native bone in three dimensions on MR images obtained at the time of diagnosis. Eight parameters of tumor size were analyzed for their value in predicting overall survival (OS) and event-free survival (EFS).
The median age of the 42 patients was 13.5 years (range: 5.9-18.7 years); 50% were female and 74% were Caucasian. Absolute tumor volume was an important predictor of OS (P < 0.05); absolute tumor depth (analyzed as a continuous variable) was a significant predictor of OS (P = 0.018) and EFS (P = 0.036). Relative measures of tumor size were not found to predict outcome. No relation was seen between tumor size and histologic response.
Absolute tumor size at the time of diagnosis is significantly predictive of OS and EFS. If validated in a larger study, this indicator should be used in the design of risk-adapted treatment protocols for osteosarcoma.

17 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: In children malignancies have characteristics distinct from tumors occurring in adults. For instance, the reported incidence is substantially lower, varying from 90 to 170 cases per 1,000,000 child years. Long-term event-free survival rates above 80% are noted in several tumors. Biology is essentially different; in pediatrics the number of mutations is limited and they are linked with specific malignancies, whereas in adults an accumulation of multiple mutations is assumed. Hereditary factors are noted in several neoplasm's. Although the linkage of syndromes with specific tumors is known for a prolonged time, currently the link with minor congenital anomalies in specific tumor types gets more prominent. Environmental factors related with an increased or a decreased risk of cancer are noted.In this review an update is given on tumor biology and treatment for several tumors, i.e. neuroblastoma, Ewing sarcoma, osteosarcoma, nephroblastoma, rhabdomyosarcoma, hepatoblastoma and retinoblastoma. Among the aspects dealt with are the occurrence of spontaneous remissions, I-meta-iodobenzylguanidine (MIBG) imaging and treatment, apoptosis induction, antisense therapy, immunotherapy, tyrosin kinase inhibition, stem cell transplantation, suicide gene therapy and anti-angiogenic therapy.
    Update on Cancer Therapeutics 09/2006; 1(3):367-383. DOI:10.1016/j.uct.2006.05.004
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To examine the prognostic relevance of c-kit expression in human osteosarcomas and to evaluate the mutation status in exon 9 and exon 11 of the c-kit gene. c-kit expression was examined in 100 human osteosarcomas by immunohistochemistry using paraffin embedded tumour tissues, and capillary sequencing of genomic DNA was performed to search for mutations in exons 9 and 11 of the c-kit gene. 20 osteosarcomas showed c-kit expression ranging from 5% to 90% (mean 5.9%; SD 16.74%). Furthermore, DNA sequences of exon 9 and exon 11 of the c-kit gene were not altered in these tumours. Overall and disease free survival analysis did not reveal any differences between patients with osteosarcoma with c-kit expression and those with c-kit negative tumours. C-kit expression is not a prognostic marker in patients with osteosarcoma. The protein expression is not linked to mutations in exon 9 or exon 11 of the c-kit gene. Therefore, these exons may not function as targets for treatment modalities based on the suppression of c-kit tyrosine kinase activity.
    Journal of Clinical Pathology 08/2007; 60(7):804-7. DOI:10.1136/jcp.2005.032839 · 2.92 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To analyze the significance of relative tumor burden in pediatric osteosarcoma. We retrospectively reviewed 241 patients with localized pediatric osteosarcoma and measured tumor size on MR images at presentation. Absolute tumor size parameters measured on MR images were converted to relative values by dividing body surface area. Both absolute and relative size parameters were analyzed for their correlation with metastasis-free survival (MFS). The 5-year MFS was 67.5 +/- 3.1%, with median follow-up of 72 months (range, 8-205 months). In addition to poor histologic response (RR 3.24; 95% CI: 1.99-5.28; P < 0.001), large relative tumor plane (RTP; RR 3.28; 95% CI: 1.72-6.25; P < 0.001), large relative tumor area (RTA; RR 4.14; 95% CI: 1.53-11.22; P = 0.005), and large absolute tumor width (ATW; RR; 3.10; 95% CI: 1.23-7.79; P = 0.02) shortened the MFS. When survival was analyzed by combining RTP and histologic response, patients with small RTP and a good response showed the best survival (5-year MFS of 90.2 +/- 3.6%), while those with large RTP and a poor response showed the worst survival (5-year MFS of 45.1 +/- 6.6%). Relative two-dimensional tumor size parameters (RTP and RTA) rather than absolute values are useful prognostic factors in pediatric osteosarcoma patients.
    Pediatric Blood & Cancer 02/2008; 50(2):195-200. DOI:10.1002/pbc.21446 · 2.39 Impact Factor
Show more