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Osteosarcoma of the Pelvis: Experience of the Cooperative Osteosarcoma Study Group

Toshifumi Ozaki, Silke Flege, Matthias Kevric, Norbert Lindner, Rainer Maas, Günter Delling, Rudolf Schwarz, Arthur R. von Hochstetter, Mechthild Salzer-Kuntschik, Wolfgang E. Berdel, Heribert Jürgens, G. Ulrich Exner, Peter Reichardt, Regine Mayer-Steinacker, Volker Ewerbeck, Rainer Kotz, Winfried Winkelmann, Stefan S. Bielack

From the Departments of Orthopaedic Surgery, Pediatric Haematology and Oncology, and Medicine/Hematology and Oncology, Westfälische Wilhelms-University, Münster; Department of Orthopaedic Surgery, University of Heidelberg, Heidelberg; Departments of Bone Pathology, Pediatric Oncology, and Radiotherapy, University Hospital Hamburg-Eppendorf, Robert-Rössle-Klinik, Berlin; Cancer Center, Ulm, Germany; Department of Orthopaedics, Balgrist, Department of Pathology, University Hospital of Zürich, Switzerland; and Department of Orthopedics, Institute of Pathological Anatomy, University of Vienna, Vienna, Austria.

Address reprint requests to Toshifumi Ozaki, MD, Department of Orthopaedic Surgery, Okayama University Medical School, Okayama 700-8558, Japan; email: tozaki{at}md.okayama-u.ac.jp.

Purpose: To define patients and tumor characteristics as well as therapy results, patients with pelvic osteosarcoma who were registered in the Cooperative Osteosarcoma Study Group (COSS) were analyzed.

Patients and Methods: Sixty-seven patients with a high-grade pelvic osteosarcoma were eligible for this analysis. Fifteen patients had primary metastases. All patients received chemotherapy according to COSS protocols. Thirty-eight patients underwent limb-sparing surgery, 12 patients underwent hemipelvectomy, and 17 patients did not undergo definitive surgery. Eleven patients received irradiation to the primary tumor site: four postoperatively and seven as the only form of local therapy.

Results: Local failure occurred in 47 of all 67 patients (70%) and in 31 of 50 patients (62%) who underwent definitive surgery. Five-year overall survival (OS) and progression-free survival rates were 27% and 19%, respectively. Large tumor size (P = .0137), primary metastases (P = .0001), and no or intralesional surgery (P < .0001) were poor prognostic factors. In 30 patients with no or intralesional surgery, 11 patients with radiotherapy had better OS than 19 patients without radiotherapy (P = .0033). Among the variables, primary metastasis, large tumor, no or intralesional surgery, no radiotherapy, existence of primary metastasis (relative risk [RR] = 3.456; P = .0009), surgical margin (intralesional or no surgical excision; RR = 5.619; P < .0001), and no radiotherapy (RR = 4.196; P = .0059) were independent poor prognostic factors.

Conclusion: An operative approach with wide or marginal margins improves local control and OS. If the surgical margin is intralesional or excision is impossible, additional radiotherapy has a positive influence on prognosis.

Supported in part by a grant from the Alexander von Humboldt Foundation. The Cooperative Osteosarcoma Study Group studies are supported by Deutsche Krebshilfe.

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