Background
The prognosis of patients with metastatic osteosarcoma remains poor. However, the chance of survival can be improved by surgical resection of all metastases. In this study we investigate the value of serum alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) in predicting the presence of metastatic disease at time of diagnosis.

Pre-treatment serum lactate dehydrogenase and alkaline phosphatase as predictors of metastases in extremity osteosarcoma.

The most prevalent primary malignant bone tumor affecting children and adolescents is osteosarcoma. Osteosarcoma is characterized by the formation of immature bone or osteoid tissue by neoplastic cells. They arise predominantly in the long bones, occasionally in the axial bones, and seldom in the soft tissues. Patients with osteosarcoma are currently treated with preoperative (neoadjuvant) chemotherapy followed by tumor resection, and further postoperative chemotherapy. Wide margin resection often is necessary and leave large bone defects. These defective bones must be reconstructed and repaired using appropriate materials and methods to restore function and structure. Currently, autograft, allograft, prosthetic implant, or a combination is used for defect reconstruction. Despite the available options, reconstruction of large bone defects and improvement in survival rates are still challenging. Tissue engineering and regenerative medicine (TERM) may be promising alternative strategies to regenerate bone and may change conventional treatment strategies in patients with osteosarcoma. TERM in the form of scaffolds, healing promotive factors, or stem cells could be designed to be useful for bone reconstruction and regeneration and also for delivery of anti-cancer therapeutic agents. Combining TERM approaches with immunotherapy, chemoimmunotherapy, radioimmunotherapy, and gene therapy together with advances in diagnostic procedures may change palliative results to curative achievements in the future. This review comprehensively discusses current options, challenges, possible strategies, and future directions in managing patients with osteosarcoma.

http://www.researchgate.net/profile/Soodeh_Alidadi/publication/271510327_Osteosarcoma_Current_concepts_challenges_and_future_directions/links/553a2b0c0cf245bdd7624e1b.pdf

Osteosarcoma: Current concepts, challenges and future directions

Background. Osteosarcoma is the most common primary malignant bone tumour. There is a high incidence of late presentation in the developing world, posing additional challenges in the treatment of this aggressive disease. Objective. To evaluate clinical outcomes of patients with osteosarcoma at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), a tertiary hospital in South Africa, and compare these with similar studies in the developing world. Methods. This was a retrospective study of 61 patients treated at CMJAH between 2007 and 2011, with a minimum follow-up of 1.3 years (range 1.3 - 6.3). Results. An average of 4.5 months elapsed before patients were first seen at the CMJAH tumour unit. Fifty-eight patients (95.1%) initially sought conventional medical care. Three patients (4.9%) presented with pathological fractures. All the patients underwent biopsy, performed an average of 3 weeks after arrival at the tumour unit. In most cases the delay was due to limited access to magnetic resonance imaging. Most patients ( n =41, 67.2%) were at Enneking stage 2B, 4 (6.6%) were at stage 2A and 16 (26.2%) were at stage 3. Of the patients, 13 (21.3%) underwent limb salvage procedures, 33 (54.1%) had amputations, 4 (6.6%) refused further treatment and 11 (18.0%) received palliative care only; 55 patients (90.2%) received chemotherapy. Two patients developed local recurrence, one of whom had an amputation and the other further wide excision. Two patients received palliative radiotherapy. Of the patients, 82.0% were HIV-negative, 4.9% HIV-positive and the rest of unknown status. At the time of the study, all but two patients, who came from other countries, were traceable or known to have died. Our overall 1-year and 5-year survival rates were 62.7% (95% confidence interval (CI) 49.1 - 73.9) and 38.1% (95% CI 24.6 - 51.4), respectively. Male patients and those with a higher Enneking stage had a poorer prognosis. Conclusion. Although most patients sought conventional medical care, unacceptable delays worsened survival. However, our survival rates are better than those in other developing countries. We advocate that professional, public and political awareness of osteosarcoma be improved as a matter of urgency, to facilitate rapid tertiary referral and expedite management.

/pdf/osteosarcoma-patient-outcomes-at-a-south-african-tertiary-71lfg0yr4e.pdf

Osteosarcoma patient outcomes at a South African tertiary hospital.

Aims The aim of this study is to determine the predictors of overall survival (OS) and predictive factors of poor prognosis of conventional high-grade osteosarcoma of the limbs in a single-centre in South Africa. Methods We performed a retrospective cross-sectional analysis to identify the prognostic factors that predict the OS of patients with histologically confirmed high-grade conventional osteosarcoma of the limbs over ten years. We employed the Cox proportional regression model and the Kaplan-Meier method for statistical analysis. Results This study comprised 77 patients at a three-year minimum follow-up. The predictors of poor OS were: the median age of ≤ 19 years (hazard ratio (HR) 0.96; 95% confidence interval (CI) 0.92 to 0.99; p = 0.021); median duration of symptoms ≥ five months (HR 0.91; 95% CI 0.83 to 0.99; p < 0.037); metastasis at diagnosis (i.e. Enneking stage III) (HR 3.33; 95% CI 1.81 to 6.00; p < 0.001); increased alkaline phosphatase (HR 3.28; 95% CI 1.33 to 8.11; p < 0.010); palliative treatment (HR 7.27; 95% CI 2.69 to 19.70); p < 0.001); and amputation (HR 3.71; 95% CI 1.12 to 12.25; p < 0.032). In contrast, definitive surgery (HR 0.11; 95% CI 0.03 to 0.38; p < 0.001) and curative treatment (HR 0.18; 95% CI 0.10 to 0.33; p < 0.001) were a protective factor. The Kaplan-Meier median survival time was 24 months, with OS of 57.1% at the three years. The projected five-year event-free survival was 10.3% and OS of 29.8% (HR 0.76; 95% CI 0.52 to 1.12; p = 0.128). Conclusion In this series of high-grade conventional osteosarcoma of the appendicular skeleton from South Africa, 58.4% (n = 45) had detectable metastases at presentation; hence, an impoverished OS of five years was 29.8%. Large-scale future research is needed to validate our results. Cite this article: Bone Jt Open 2024;5(3):210–217.

Prognostic factors for overall survival of conventional osteosarcoma of the appendicular skeleton

Background: Among the solid malignancies of bone, osteosarcomas are the most common, but unfortunately there has not been solid new therapy for this disease. In this study, we emphasized on the prognostic markers of the disease and our goal was to present the clinical and demographic outcomes of osteosarcoma patients.
Materials and Methods: A total of 30 patients (17 male, 13 female) osteosarcoma patients treated and followed up in Middle Euphrates Cancer Center Therapy in Najaf, Iraq from 2016 to 2017 were reviewed prospectively and retrospectively. Serum alkaline phosphatase (ALP), lactate dehydrogenase (LDH) and bone-specific ALP (bsALP) were analyzed both before and after chemotherapy. Patients were also examined by magnetic resonance imaging (MRI).
Results: Seventeen male and thirteen female patients were diagnosed with metastatic (except one male and one female) osteosarcoma located at extremities. The patients showed an increase in the level of serum alkaline phosphatase (ALP), lactate dehydrogenase (LDH), bone specific ALP. A strong correlation was demonstrated between LDH and MRI results.
Conclusions: In this study, LDH and MRI were found to be the most important prognostic factors in osteosarcoma patients. An increase in serum level of ALP, LDH, and bone specific ALP was observed. A Significant correlation was indicated between LDH and MRI results. An increase in sample size and the use of more effective and active agents of chemotherapy, especially for metastatic cases are needed.

Prognostic Markers in Osteosarcoma Patients in the Najaf Province of Iraq

consecutive cases of osteosarcoma treated over a five-year period were reviewed retrospectively. The cases were notable for the advanced stage of disease at presentation with half the patients presenting with metastases, and unusually large mean tumour sizes. The majority of patients needed amputation for local control of the tumour. Although follow-up is short, a third of the patients are disease-free at a mean of 30 months and a sixth alive with metastases at a mean of 16 months. Half the patients are presumed or known to be dead. Presence of metastases at diagnosis and size greater than 10 cm were associated with a poor prognosis.

/pdf/outcomes-of-osteosarcoma-in-a-tertiary-hospital-3fvcwuq6xz.pdf

Outcomes of osteosarcoma in a tertiary hospital

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Outcomes of osteosarcoma in a tertiary hospital