A systematic literature analysis of clinical curative effects of local recurrent osteosarcoma

WANG Wen-jian; YU Xiu-chun

doi:10.3969/j.issn.2095-252X.2017.06.005

Abstract：Objective To analyze the epidemiological characteristics of the patients with local recurrent osteosarcoma and the effects of surgical treatment and chemotherapy on the survival rate after local recurrence, and to investigate the clinical treatment strategy for local recurrent osteosarcoma. Methods We searched "osteosarcoma;neoplasm recurrence, local; review" in the databases. All 1184 articles were used for analysis, and through secondary screening of the titles, abstracts and full texts, a total of 20 articles met the inclusion criteria. The patients with local recurrent osteosarcoma were taken as the research objects, and the repeated case reports were deleted. We collected gender, age, tumor site, survival rate after local recurrence, the first mode of operation, preoperative and postoperative chemotherapy regiments, mode of operation after local recurrence, second-line chemotherapy and factors influencing survival rate of each patient. We used systematic analysis method to analyze the data. Results In the 20 articles, a total of 45 patients with local recurrent osteosarcoma were included in the study, whose data were systematically analyzed. The first onset age was 5 - 66 years, and the average age was 21.8 years. The age vulnerable to local recurrent osteosarcoma was 10 - 25 years, accounting for 77.8% ( 21 / 27 ) of the total. The male and female ratio was 1 : 1. The tumor site was in the distal femur in 23 cases, proximal tibia in 13 cases, proximal humerus in 2 cases, proximal femur in 2 cases, tibial shaft in 2 cases, total femur in 1 case, distal tibia in 1 case and fibula in 1 case. The follow-up time was 0.5 - 22.6 years, with an average of 8.4 years. The 5-year survival rate after recurrence was 28.6%. Chemotherapy after relapse had no significant effects on the survival rate. The survival rate of the patients who underwent surgical treatment was higher than that of non-operative patients. The main surgical approach was amputation, accounting for 71.0% of the patients ( 22 / 31 ). The chemotherapy after local recurrence had no uniform standard. Eleven patients received second-line chemotherapy with 9 chemotherapy regimens, including cisplatin, adriamycin, cyclic amide and large doses of methotrexate ( n = 3 ), pemetrexed, cisplatin and endostar ( n = 1 ), epirubicin, large doses of methotrexate and cisplatin ( n = 1 ), cisplatin, adriamycin and large doses of methotrexate ( n = 1 ), cisplatin, adriamycin and cyclic amide ( n = 1 ), cisplatin, adriamycin, cyclic amide and etoposide ( n = 1 ), etoposide and ifosfamide ( n = 1 ), ifosfamide, etoposide and caffeine ( n = 1 ) and docetaxel and gemcitabine ( n = 1 ). Conclusions Postoperative local recurrence in most patients with osteosarcoma occur within 2 years after operation. The most frequently involved sites are the distal femur, proximal tibia and proximal humerus. The postoperative survival rate is significantly decreased after local recurrence. Treatment is mainly based on amputation, but second-line chemotherapy after relapse is not uniform. Therefore, there is no effective strategy for the treatment of recurrent osteosarcoma, and we need to study and explore the related issues.