Osteosarcoma natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Prognosis

Pretreatment factors that influence outcome include the following:

Primary tumor site

Pelvis

• Survival rates for patients with pelvic primary tumors are 20% to 47%.
• Complete surgical resection is associated with positive outcome for osteosarcoma of the pelvis.

Craniofacial/head and neck

• In patients with craniofacial osteosarcoma, those with mandibular tumors have a significantly better prognosis than do patients with extragnathic tumors.

Extraskeletal

• With current combined-modality therapy, the outcome for patients with extraskeletal osteosarcoma appears to be similar to that for patients with primary tumors of bone.

Size of the primary tumor

• Larger tumors have a worse prognosis than smaller tumors.
• Serum lactate dehydrogenase (LDH), which also correlates with outcome, is a likely surrogate for tumor volume.

Metastatic disease

• Patients with localized disease have a much better prognosis than do patients with overt metastatic disease.

After administration of preoperative chemotherapy, factors that influence outcome include the following:

• Surgical resectability.
• Degree of tumor necrosis.

In general, prognostic factors in osteosarcoma have not been helpful in identifying patients who might benefit from treatment intensification or who might require less therapy while maintaining an excellent outcome.