Osteosarcoma of the spine: Dismal past, any hope for the future?

Abstract Purpose. The purpose of this study was to analyse all cases of spinal osteosarcoma (OS) treated in a regional bone tumour unit over the last 27 years. We were primarily interested in overall survival following tumour surgery, and if there is a difference in the survival of patients undergoi...

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Bibliographic Details
Published in:British journal of neurosurgery 2014-08, Vol.28 (4), p.495-502
Main Authors: Bhatia, Robin, Beckles, Verona, Fox, Zoe, Tirabosco, Roberto, Rezajooi, Kia, Casey, Adrian T. H.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Back surgery
Bone cancer
chemotherapy
Child
Clinical outcomes
Databases, Factual
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Neoplasm Recurrence, Local - mortality
Neurology
Oncology
operative
Osteosarcoma - mortality
Osteosarcoma - surgery
Spinal Neoplasms - mortality
Spinal Neoplasms - surgery
spine
Survival analysis
Treatment Outcome
Tumors
tumour
Young Adult
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Summary:Abstract Purpose. The purpose of this study was to analyse all cases of spinal osteosarcoma (OS) treated in a regional bone tumour unit over the last 27 years. We were primarily interested in overall survival following tumour surgery, and if there is a difference in the survival of patients undergoing en bloc resection versus non-en bloc surgery. Methods. Prospectively maintained tumour databases were searched in a regional bone tumour unit. All cases of surgically managed spinal OS were extracted and inpatient notes, imaging (including staging), histological margin status, and outcomes (neurological deficit and survival curves) were reviewed. Results. Twenty-six patients were identified between 1985 and 2012. The median age was 26.5 years (range 6-78 y). Overall Kaplan-Meier survival was 69.5% (95% CI: 46.3-84.2%) and 10.8% (95% CI: 1.8-29.0%) at 1 and 5 years, respectively. There appears to be improved survival associated with primary spinal OS compared to that of metastatic disease, but this does not reach statistical significance (p = 0.29, Cox proportional hazards analysis). En bloc resection results in a significantly improved survival time compared to non-en bloc (biopsy and debulking): 44.1% alive at 2 years compared to 9.4%, respectively, p = 0.009. Conclusions. En bloc resection for primary spinal OS is associated with improved survival; there have been major changes in both surgical treatment and chemo/radiotherapy regimens over the period studied, potentially confounding the interpretation.
ISSN:0268-8697
1360-046X
DOI:10.3109/02688697.2013.869550