Parosteal osteosarcoma.

In this retrospective clinical study, 6 cases of osteosarcoma of the bone have been analyzed. Five patients were with parosteal osteosarcoma and one with periosteal osteosarcoma. The study was performed at the Clinic for Orthopaedic Surgery in Skopje, Macedonia, from 1995 to 2005. This tumor represents 1.5% of all primary bone tumors treated at the Clinic in the 11 year period. The age of the 6 patients (2 female and 4 male) ranged from 8 to 39 years (average 23.8). The history analysis of the patients showed misinterpreted diagnosis in 50% of the cases, with 83.3% rate of local recurrence, 33.3% of metastases and 33.3% of mortality. Follow-up varied from 11 months to 9 years (average 4.5). The clinical and histopathological findings (identical with those reviewed in the literature) confirmed occurrence of two biologically different types of parosteal osteosarcoma: predominant type is originally "benign" but has a definite malignant potential, causing metastases after long symptom-free interval. The other type is highly malignant from the beginning. More radical surgery is recommended for the latter category of tumors, followed by chemotherapy. Compartmental, radical "en bloc" resection, followed by regular review of the patients, is recommended for the former (Tab. 1, Fig. 3, Ref. 20). Full Text (Free, PDF) www.bmj.sk.

Limb-sparing in patients with non-metastatic high-grade osteosarcoma.

PURPOSE: To improve survival rates and functional outcome in patients with non-metastatic, high-grade osteosarcoma of the extremities, using the Scandinavian Sarcoma Group XIV neoadjuvant chemotherapy protocol. PATIENTS AND METHODS: The analysis included 37 patients treated during the period 2000-2005. Age range was 8 to 65 year (median 23). Seven (7/37) patients were excluded from the study. The remaining 30 patients received 2 cycles of preoperative chemotherapy (high dose methotrexate, cisplatin and doxorubicin). Surgery was carried out in the 9th week. Twenty-seven (90%) patients had limb-salvage operation and in the remaining 3 amputation was performed. Based on the histopathological assessment of the removed tumor patients were classified in two groups (regarding good or poor response to chemotherapy). All 30 patients received 3 courses of postoperative chemotherapy with the same regimen. Patients with poor response received 3 more cycles of chemotherapy with high dose ifosfamide. Follow-up was 2-8 years (mean 52 months). RESULTS: Histopathological assessment showed poor response to neoadjuvant chemotherapy in 57% of the patients but no significant difference in 3-year survival between the 2 groups was noted. Three-year survival of the patients with local recurrence was 40 vs. 88% of those without local recurrence (p=0.013). Three-year survival of the patients with distant metastases was 20 vs. 92% of those without distant metastases (p=0.0002). Three-year overall survival (OS) was 80% and disease-free survival (DFS) 60% for all 30 patients. CONCLUSION: Neoadjuvant chemotherapy in patients with high-grade osteosarcoma of the extremities gives the opportunity for limb-sparing operation and at the same time improves survival rates.

Prognostic factors in patients with recurrent head and neck cancer treated with reirradiation.

PURPOSE: The aim of this study was to determine the prognostic factors concerning overall survival (OS) and progression- free survival (PFS) following reirradiation in patients with recurrent squamous cell head and neck cancer (HNC). PATIENTS AND METHODS: We performed a retrospective analysis on 65 recurrent HNC patients treated with reirradiation for local/locoregional recurrence between 1999 and 2004 at the Institute of Radiotherapy and Oncology in Skopje. The initial treatment of their HNC consisted of radiotherapy following surgery, radiotherapy alone, or concurrent chemoradiotherapy. RESULTS: The median reirradiation dose was 39.8 Gy (range 24-58). Clinically complete response (CR) was observed in 9 (13.9%) patients. The median OS and PFS was 8 months (range 1-22) and 4.9 months (range 0-18), respectively. The univariate analysis of prognostic factors identified Karnofsky performance status (KPS), response to reirradiation, dose to recurrent site, and disease-free interval (DFI) as strongly associated with both OS and PFS. Initial tumor site and cumulative dose had a significant influence only on OS. Multivariate analysis revealed that response to reirradiation and the radiation dose to the recurrent site were two independent variables significantly influencing OS (p<0.0001 and p=0.049, respectively). The only significant independent prognostic factor for PFS was response to reirradiation (p=0.0008). CONCLUSION: The necessity of improvement of patients' outcome allows us to consider concurrent chemoradiotherapy as a more efficient treatment strategy that has a potential to increase the response to reirradiation of unresectable recurrent HNC. Using higher radiation doses is also expected to enhance the response rates and consequently to positively influence OS and PFS.

Treatment of non-metastatic high-grade osteosarcoma (study of 30 cases treated with Scandinavian osteosarcoma protocol XIV and surgery).

UNLABELLED: The aim of this study is to improve 3-years survival rates and functional outcome in high-grade osteosarcoma patients treated with amputations and limb-sparing surgery, introducing Scandinavian Sarcoma Group chemotherapy protocol (SSG XVI). PATIENTS AND METHODS: During the period 2000-2005, thirty seven patients with high-grade, non-metastatic osteosarcoma on the extremities were treated at the Clinic for Orthopaedic Surgery in Skopje. Mail patients were 21 (57%) and female were 16 (43%). Patients age varied from 8 to 63 years (mean 18 +/- 13). Seven patients (7/37) did not comply with including criteria and were excluded from the study. The rest 30 patients were introduced to two courses of pre-operative chemotherapy (high doses of Methotrexate, Cisplatin and Adriamycin). Surgical treatment was in 9-th week of the protocol. In 27/30 (90%) of the patients limb-sparing surgery was done, and in 3/30 (10%) amputations were performed. Histopathological assessment of the tumour after the neo-adjuvant chemotherapy divided the patients into group with bad and group with good response. All the patients had 3 more courses of chemotherapy after surgery (same as the preoperative). Patients with bad response were introduced to 3 more cycles of 5 days with high-dose of Ifosfamide. Follow-up was from 2 to 8 years, mean 51 months. RESULTS: Histopathological assessment showed that 57% of the patients had bad response to neo-adjuvant chemotherapy, but there was no statistical significance in the survival time of the groups (p = 0.06). Three-years survival time was 40% of the patients with local recurrence in comparison with 80% of the patients with no local recurrence. Three-years survival time was 20% of the patients with distant metastases in comparison with 92% of the patients with no metastases. Overall survival time (OS) was 80%. After 3 years 60% of the patients were disease-free (DFS). CONCLUSION: High-grade osteosarcoma of the extremities treated with modern chemotherapy protocols enables limb-sparing in the same time with improved survival time of the patients. Introducing high-dose Ifosfamide in treatment of patients with bad response after neo-adjuvant chemotherapy improves their functional results as well as the survival time. Key words: osteosarcoma, neo-adjuvant chemotherapy, limb-sparing.