Postrelapse S urvival i n O steosarcoma o f t he E xtremities: Prognostic F actors f or L ong-Term S urvival

Purpose: To identify factors that influence postrelapse survival (PRS) in patients with nonmetastatic osteosarcoma of the extremity Patients and Methods: One hundred sixty-two patients with recurrent osteosarcoma of the extremity were retrospectively reviewed. The first-line treatment included surgery of the primary lesion and chemotherapy with methotrexate, doxorubicin, cisplatin, and ifosfamide. Results: The projected 5-year PRS rate was 28%. Patients who had complete surgery of recurrence had a 5-year PRS of 39%, whereas for those who did not have complete surgery, PRS was 0% at 3 years (P 24 months, 60%; P < .0001), and number of lung metastases (5-year PRS, two or fewer nodules, 59%; more than two nodules, 14%; P < .0001) but not by the use of a second-line chemotherapy treatment. Conclusion: RFI, site of metastases, and number of pulmonary nodules are the main prognostic factors for PRS in osteosarcoma. Complete surgery of recurrence is pivotal in the strategy of treatment. Patients with unresectable recurrence benefit from second-line chemotherapy, whereas our data do not support a generalized use of chemotherapy after complete surgery of first recurrence. J Clin Oncol 21:710-715. © 2003 by American Society of Clinical Oncology. H IGH-GRADE osteosarcoma is a malignant bony tumor with a peak of incidence in the second decade of life. When treated by surgery alone, usually amputation, the cure rate was approximately 10%, but the use of chemotherapy has significantly improved the clinical outcome. 1 Recurrent disease still occurs in approximately 30% to 40% of patients with nonmetastatic osteosarcoma of the extremity despite a complete surgical removal of the tumor and intensive chemotherapeutic treatment. 2-6 The postrelapse survival (PRS) in this subset of chemotherapy-resistant patients is usually low. An aggressive and even repeated pulmonary metastasectomy is at present an accepted strategy of treatment in patients with