1
|
Alduraibi KA, Towhari JA, Alebdi HA, Alfadhel BZ, Alotaibi GS, Ghosh S, Bin Saeedan M. Osteosarcoma Metastasis to the Thorax: A Pictorial Review of Chest Computed Tomography Findings. Diagnostics (Basel) 2024; 14:2085. [PMID: 39335763 PMCID: PMC11431112 DOI: 10.3390/diagnostics14182085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 09/03/2024] [Accepted: 09/16/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Osteosarcoma, a primary bone malignancy in children and adolescents, frequently metastasizes to the lungs, contributing significantly to morbidity and mortality. Lung Metastases: At diagnosis, 15-20% of patients present with detectable lung metastases. Chest computed tomography (CT) is vital for the early detection and monitoring of these metastases. Lung involvement typically presents as multiple nodules of varying sizes and can include atypical features such as cavitation, cystic lesions, ground-glass halos, intravascular tumor thrombi, and endobronchial disease. Additional Findings: Pleural metastasis often occurs alongside pulmonary disease, and complications like spontaneous pneumothorax may arise. Additional findings may include thoracic lymphadenopathy, cardiac tumor thrombus, and chest wall deposits. Conclusion: Familiarity with these imaging patterns is essential for radiologists to ensure timely diagnosis and effective management. This review highlights the critical role of chest CT in detecting and characterizing osteosarcoma metastasis.
Collapse
Affiliation(s)
- Khalid Abdulaziz Alduraibi
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh 11533, Saudi Arabia
| | - Jawaher Ali Towhari
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh 11533, Saudi Arabia
| | - Hatim Abdullah Alebdi
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh 11533, Saudi Arabia
| | - Bader Zaid Alfadhel
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh 11533, Saudi Arabia
| | - Ghazi S Alotaibi
- Division of Hematology, Department of Medicine, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
| | - Subha Ghosh
- Department of Radiology, Thoracic Imaging, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Mnahi Bin Saeedan
- Department of Radiology, Thoracic Imaging, Cleveland Clinic, Cleveland, OH 44195, USA
| |
Collapse
|
2
|
Obu S, Niture S, Hoang H, Gadi S, Vandana, He Y, Kumar D. Clemastine and hyperthermia enhance sensitization of osteosarcoma cells for apoptosis. Mol Cell Oncol 2024; 11:2351622. [PMID: 38778919 PMCID: PMC11110698 DOI: 10.1080/23723556.2024.2351622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024]
Abstract
Clemastine is an antagonist of histamine H1 receptor may provide benefits in the treatment of osteosarcoma (OS). In the current study, we used hyperthermia approach to sensitize OS cells to clemastine-mediated cell death. Osteosarcoma U-2 OS and Saos-2 cells were treated with clemastine at 37°C, followed by 42°C for 2 h, and released at 37°C for 6 h. The impact of clemastine and hyperthermia on OS cell survival and autophagy-mediated cell death was investigated. Exposure of U-2 OS and Saos-2 cells to clemastine and hyperthermia (42°C) inhibited dose-dependent clemastine-mediated cell survival by increasing cell apoptosis. Hyperthermia and clemastine exposure modulated inflammatory and unfolded protein response (UPR) signaling differentially in U-2 OS and Saos-2 cells. Exposure of U-2 OS and Saos-2 cells to hyperthermia and clemastine inhibited AKT/mTOR and induced expression of the autophagy biomarkers LC3B II and LC3-positive puncta formation. The inhibition of autophagy by 3-methyladenine blocked hyperthermia and clemastine-mediated induction of LC3B II, LC3-positive puncta formation, and OS cell apoptosis. These results indicate that clemastine and hyperthermia sensitize OS cell lines by inducing increased autophagic cell death. Collectively, our data suggest that hyperthermia along with antihistamine therapy may provide an improved approach for the treatment of OS.
Collapse
Affiliation(s)
- Somtochukwu Obu
- The Julius L. Chambers Biomedical/Biotechnology Research Institute (JLC-BBRI), North Carolina Central University (NCCU), Durham, NC, USA
| | - Suryakant Niture
- The Julius L. Chambers Biomedical/Biotechnology Research Institute (JLC-BBRI), North Carolina Central University (NCCU), Durham, NC, USA
| | - Hieu Hoang
- The Julius L. Chambers Biomedical/Biotechnology Research Institute (JLC-BBRI), North Carolina Central University (NCCU), Durham, NC, USA
| | - Sashi Gadi
- The Julius L. Chambers Biomedical/Biotechnology Research Institute (JLC-BBRI), North Carolina Central University (NCCU), Durham, NC, USA
| | - Vandana
- The Julius L. Chambers Biomedical/Biotechnology Research Institute (JLC-BBRI), North Carolina Central University (NCCU), Durham, NC, USA
| | - Yiping He
- Department of Pathology, Duke University Medical Center, Duke University Durham, Durham, NC, USA
| | - Deepak Kumar
- The Julius L. Chambers Biomedical/Biotechnology Research Institute (JLC-BBRI), North Carolina Central University (NCCU), Durham, NC, USA
| |
Collapse
|
3
|
Luo Y, Sun M, Tan L, Li T, Min L. Nano-Based Drug Delivery Systems: Potential Developments in the Therapy of Metastatic Osteosarcoma-A Narrative Review. Pharmaceutics 2023; 15:2717. [PMID: 38140058 PMCID: PMC10747574 DOI: 10.3390/pharmaceutics15122717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
Osteosarcoma, a predominant malignant bone tumor, poses significant challenges due to its high metastatic and recurrent nature. Although various therapeutic strategies are currently in use, they often inadequately target osteosarcoma metastasis. This review focuses on the potential of nanoscale drug delivery systems to bridge this clinical gap. It begins with an overview of the molecular mechanisms underlying metastatic osteosarcoma, highlighting the limitations of existing treatments. The review then transitions to an in-depth examination of nanoscale drug delivery technologies, emphasizing their potential to enhance drug bioavailability and reduce systemic toxicity. Central to this review is a discussion of recent advancements in utilizing nanotechnology for the potential intervention of metastatic osteosarcoma, with a critical analysis of several preclinical studies. This review aims to provide insights into the potential applications of nanotechnology in metastatic osteosarcoma therapy, setting the stage for future clinical breakthroughs and innovative cancer treatments.
Collapse
Affiliation(s)
- Yuanrui Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610064, China; (Y.L.); (M.S.); (L.T.)
| | - Minghao Sun
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610064, China; (Y.L.); (M.S.); (L.T.)
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, Chengdu 610064, China
| | - Linyun Tan
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610064, China; (Y.L.); (M.S.); (L.T.)
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, Chengdu 610064, China
| | - Tao Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610064, China; (Y.L.); (M.S.); (L.T.)
| | - Li Min
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610064, China; (Y.L.); (M.S.); (L.T.)
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, Chengdu 610064, China
| |
Collapse
|
4
|
Xie L, Cai Z, Lu H, Meng F, Zhang X, Luo K, Su X, Lei Y, Xu J, Lou J, Wang H, Du Z, Wang Y, Li Y, Ren T, Xu J, Sun X, Tang X, Guo W. Distinct genomic features between osteosarcomas firstly metastasing to bone and to lung. Heliyon 2023; 9:e15527. [PMID: 37205995 PMCID: PMC10189180 DOI: 10.1016/j.heliyon.2023.e15527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 03/26/2023] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Abstract
Background Osteosarcoma initially metastasing to bone only shows distinct biological features compared to osteosarcoma that firstly metastasizes to the lung, which suggests us underlying different genomic pathogenetic mechanism. Methods We analyzed whole-exome sequencing (WES) data for 38 osteosarcoma with paired samples in different relapse patterns. We also sought to redefine disease subclassifications for osteosarcoma based on genetic alterations and correlate these genetic profiles with clinical treatment courses to elucidate potential evolving cladograms. Results We investigated WES of 12/38 patients with high-grade osteosarcoma (31.6%) with initial bone metastasis (group A) and 26/38 (68.4%) with initial pulmonary metastasis (group B), of whom 15/38 (39.5%) had paired samples of primary lesions and metastatic lesions. We found that osteosarcoma in group A mainly carries single-nucleotide variations displaying higher tumor mutation burden and neoantigen load and more tertiary lymphoid structures, while those in group B mainly exhibits structural variants. High conservation of reported genetic sequencing over time in their evolving cladograms. Conclusions Osteosarcoma with mainly single-nucleotide variations other than structural variants might exhibit biological behavior predisposing toward bone metastases as well as better immunogenicity in tumor microenvironment.
Collapse
Affiliation(s)
- Lu Xie
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Zhenyu Cai
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Hezhe Lu
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, No. A3 Datun Road, Chaoyang District, Beijing 100101, China
| | - Fanfei Meng
- Shanghai OrigiMed Co., Ltd, Shanghai, No. 3576 Zhaolou Road, Minhang District, Shanghai, 201112, China
| | - Xin Zhang
- Shanghai OrigiMed Co., Ltd, Shanghai, No. 3576 Zhaolou Road, Minhang District, Shanghai, 201112, China
| | - Kun Luo
- Shanghai OrigiMed Co., Ltd, Shanghai, No. 3576 Zhaolou Road, Minhang District, Shanghai, 201112, China
| | - Xiaoxing Su
- Berry Oncology Corporation, Fuzhou, 350200, China
| | - Yan Lei
- Berry Oncology Corporation, Fuzhou, 350200, China
| | - Jiuhui Xu
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Jingbing Lou
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Han Wang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Zhiye Du
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Yunfan Wang
- Pathology Department, Peking University Shougang Hospital, No. 9 Jinyuanzhuang Road, Shijingshan District, Beijing, 100144, China
| | - Yuan Li
- Radiology Department & Nuclear Medicine Department, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Tingting Ren
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Jie Xu
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Xin Sun
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
- Corresponding author.
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
- Corresponding author.
| |
Collapse
|
5
|
Gotta J, Bochennek K, Klingebiel T, Bielack S, Wild PJ, Demes MC, Gradhand E. Metachronous Osteosarcoma, A Differential Diagnosis to be Considered in Children With Osteosarcoma: A Review of Literature and a Case From Our Center. J Pediatr Hematol Oncol 2023; 45:105-110. [PMID: 36251795 PMCID: PMC10030169 DOI: 10.1097/mph.0000000000002560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/21/2022] [Indexed: 11/27/2022]
Abstract
Metachronous osteosarcomas (MOS) are currently defined as tumors that arise in a way and site unusual for typical metastasis. In this article, we reviewed the recent literature on the occurrence of metachronous osteosarcoma and presented a case from our center. Our patient, a 10-year-old girl, presented with metachronous osteoblastic osteosarcoma of the left distal femur ∼5 years after the successful treatment for osteosarcoma of the right distal femur. Even after several relapses, complete remission (CR) was achieved after the first osteosarcoma and after the metachronous osteosarcoma. The literature research revealed that metachronous osteosarcoma occurs in 3.4 to 5.4% of osteosarcoma patients. The time interval between the diagnosis of the initial osteosarcoma and the metachronous tumor ranged from 0.2 to 14.3 years (median 2.5 y). MOS appears to have differences in localization and metastatic spread, as well as a different survival pattern compared with primary osteosarcoma and osteosarcoma recurrence. Survival (median 4.3 y, range 0 to 24.6 y) appears to be associated with the time interval to diagnosis of MOS. In particular, early MOS (<24 mo after primary diagnosis) seem to have a poorer prognosis. Therefore, the occurrence of MOS at oncological unusual sites should be considered as a differential diagnosis in osteosarcoma survivors.
Collapse
Affiliation(s)
| | - Konrad Bochennek
- Department for Children and Adolescents Medicine, University Hospital Frankfurt, Frankfurt am Main
| | - Thomas Klingebiel
- Department for Children and Adolescents Medicine, University Hospital Frankfurt, Frankfurt am Main
| | - Stefan Bielack
- Center for Pediatric, Adolescent and Women’s Medicine, Olgahospital, Department of Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart, Stuttgart, Germany
| | - Peter J. Wild
- Dr Senckenberg Institute of Pathology
- Frankfurt Institute for Advanced Studies (FIAS)
- Wildlab, University Hospital MVZ GmbH, Frankfurt am Main
| | - Melanie C. Demes
- Dr Senckenberg Institute of Pathology
- Wildlab, University Hospital MVZ GmbH, Frankfurt am Main
| | | |
Collapse
|
6
|
Lu KH, Lu PWA, Lin CW, Yang SF. Curcumin in human osteosarcoma: From analogs to carriers. Drug Discov Today 2023; 28:103437. [PMID: 36372327 DOI: 10.1016/j.drudis.2022.103437] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/11/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
Osteosarcoma (osteogenic sarcoma), the most prevalent primary malignant bone tumor in adolescents, confers low survival rates in patients with metastatic disease. Dietary curcumin has a number of anticancer properties but has poor bioavailability. To improve the clinical applications of curcumin, several potential curcumin analogs and nanobased curcumin delivery systems have been developed. In this critical review, we address the biological and pharmacological characteristics of curcumin and its analogs, with an emphasis on strategies to improve the bioactivity and bioavailability of curcumin analogs that may increase their application in the treatment of potent human metastatic osteosarcoma. We highlight promising current multifunctional nanoformulations and three-dimensional printed scaffold systems utilized for the targeting and delivery of curcumin in human osteosarcoma cells. Our purpose is to drive further research on curcumin analogs and carriers to improve their bioavailability and anti-osteosarcoma bioactivity.
Collapse
Affiliation(s)
- Ko-Hsiu Lu
- Department of Orthopedics, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | | | - Chiao-Wen Lin
- Institute of Oral Sciences, Chung Shan Medical University, Taichung, Taiwan; Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
7
|
Jiang D, Wang J, Chen Q, Wu J, Xu M, Yu X. Comprehensive conservative treatment for multiple metastases of skull osteosarcoma: A case report. Front Neurol 2023; 14:1037673. [PMID: 36779058 PMCID: PMC9909182 DOI: 10.3389/fneur.2023.1037673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
Background Skull osteosarcoma is relatively rare, and it is difficult to be diagnosed according to medical history and imaging examination due to the complex structure and diverse components of the brain. Consequently, there is only a limited number of patients who can undergo neoadjuvant chemotherapy before the operation. Although neoadjuvant chemotherapy plays an important role in the treatment of osteosarcoma, there is still a "bottleneck" in the current treatment method which when pulmonary metastasis occurs, or surgical treatment is not Enneking appropriate. Under such circumstances, the choice of treatment can be an issue. Case A 16-year-old male patient with multiple metastases of skull osteosarcoma was reported. The patient suffered not only tinnitus and hearing loss in the right ear but also right facial paralysis and headache. The preoperative brain MRI showed a tumor in the right cerebellopontine angle (CPA) area. He underwent skull tumor resection at another hospital in November 2018, during which process the biopsy revealed epithelioid osteoblastoma-like osteosarcoma. The patient had supplemental radiotherapy 1 month after surgery because of tumor recurrence. 32 months afterward, pulmonary metastases and multiple bone metastases were found. Then the patient underwent multiple conservative treatments which include Denosumab, Anlotinib, and DIA (cisplatin + ifosfamide + doxorubicin) chemotherapy at our hospital. After a series of 6 cycles of treatment, the patient can walk without aid. Lactate dehydrogenase (LDH) and Alkaline phosphatase (AKP) returned to a normal level. Fluorodeoxyglucose (FDG) metabolism in all bone metastases decreased to normal except for the ones in the proximal left femur, and the FDG metabolism in the left femur is significantly lower than that before treatment. Multiple bone metastases showed different extents of high-density calcification, and the volume of the local bone metastases has been reduced significantly. The patient's condition stayed stable at latest follow-up. Conclusion We found that multiple conservative treatments, which include Denosumab, Anlotinib and DIA chemotherapy, can improve patients' life quality, and help avoid further osteolytic destruction for patients with skull osteosarcoma and multiple metastases. Its specific mechanism and scope of the application still need to be further studied.
Collapse
|
8
|
Cai Z, Xu J, Sun X, Zhang R, Xie L, Wang J, Tang X, Yang R, Guo W. How to confront the high prevalence of pulmonary micro nodules (PMNs) in osteosarcoma patients? INTERNATIONAL ORTHOPAEDICS 2022; 46:2425-2436. [PMID: 35941258 DOI: 10.1007/s00264-022-05534-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Pulmonary metastasis was a negative factor of osteosarcoma prognosis. However, there is no universal criteria to confirm pulmonary metastasis at pulmonary micro nodule (PMN, Dmax ≤ 5 mm) stage other than pathology. We aimed to identify prevalence of PMNs, determine prognosis of osteosarcoma with PMNs, and analyze risk factors related to PMN progression. METHODS We retrospectively reviewed 425 consecutive osteosarcoma patients. According to dynamic change in size and number of PMNs, patients were divided into PMN progression and non-progression group. Demographic data, initial laboratory data, radiological features, and oncological evaluations were analyzed. Cox regression was used to identify risk factors for PMN progression. Overall survival rate was measured and analyzed with Kaplan-Meier method. Differences with p < 0.05 were considered significant. RESULTS PMNs were found in 74% (315/425) osteosarcoma patients, half of whom (157/315) suffering PMN progression. Overall survival rate was 70.2%, while survival rates for PMN progression group and non-progression group were 53.40% and 87.40%, respectively. Clinical risk factors for PMN progression in certain patients included blood vessel invasion, extrapulmonary metastases, low tumour cell necrosis rate, and large tumour size. Radiologic risk factors included greatest diameter, distance to pleura, CT value, solid components, and smooth border. CONCLUSION PMN is quite common in osteosarcoma patients. PMN progression is related to both certain clinical and radiological factors, which could assist surgeons to determine its possibility to progress at an early stage.
Collapse
Affiliation(s)
- Zhenyu Cai
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Jie Xu
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Xin Sun
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Ranxin Zhang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Lu Xie
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Jichuan Wang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China.
| |
Collapse
|
9
|
The Potential In Vitro Inhibitory Effects of Neurokinin-1 Receptor (NK-1R) Antagonist, Aprepitant, in Osteosarcoma Cell Migration and Metastasis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8082608. [PMID: 36177059 PMCID: PMC9514929 DOI: 10.1155/2022/8082608] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/14/2022] [Accepted: 09/03/2022] [Indexed: 11/17/2022]
Abstract
Background Osteosarcoma, the most frequent osteogenic malignancy, has become a serious public health challenge due to its high morbidity rates and metastatic potential. Recently, the neurokinin-1 receptor (NK-1R) is proved to be a promising target in cancer therapy. This study is aimed at determining the effect of aprepitant, a safe and Food and Drug Administration (FDA) approved NK-1R antagonist, on osteosarcoma cell migration and metastasis, and to explore its underlying mechanism of action. Methods Colorimetric MTT assay was employed to assess cell viability and cytotoxicity. A wound-healing assay was used to examine migration ability. The desired genes' protein and mRNA expression levels were measured by western blot assay and quantitative real-time PCR (qRT-PCR), respectively. Gelatinase activity was also measured by zymography. Results We found that aprepitant inhibited MG-63 osteosarcoma cell viability in a dose-dependent manner. We also observed that aprepitant inhibited the migrative phenotype of osteosarcoma cells and reduced the expression levels and activities of matrix metalloproteinases (MMP-2 and MMP-9). Aprepitant also reduced the expression of an angiogenic factor, VEGF protein, and NF-κB as an important transcriptional regulator of metastasis-related genes. Conclusion Collectively, our observations indicate that aprepitant modulates the metastatic behavior of human osteosarcoma cells, which may be applied to an effective therapeutic approach for patients with metastatic osteosarcoma.
Collapse
|
10
|
Prevalence, Risk Factors, and Prognostic Factors of Primary Malignant Bone Neoplasms with Bone Metastasis at Initial Diagnosis: A Population-Based Study. JOURNAL OF ONCOLOGY 2022; 2022:9935439. [PMID: 35378768 PMCID: PMC8976614 DOI: 10.1155/2022/9935439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/20/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022]
Abstract
Background. Bone metastasis (BM) has been proven to be responsible for the poor prognosis of primary malignant bone neoplasms (PMBNs). We aimed to identify the prevalence, risk factors, and prognostic factors for PMBNs patients with BM based on the Surveillance, Epidemiology, and End Results (SEER) database. Methods. 4,758 patients diagnosed with PMBNs from 2010 to 2018 were selected from the SEER database. All patients were divided into two groups: the BM group or the non-BM group. Pearson’s chi-square test and Fisher’s exact method were used to assess baseline characteristics, and logistic regression analysis was applied to assess risk factors. In addition, a nomogram was constructed based on the results of Cox regression analysis among 227 patients with BM. The good performance and clinical applicability of the nomogram were tested by the concordance index, operating characteristic curve, area under the curve, calibration curves, and decision curve analysis. Results. 227 (4.8%) patients had metastasis to bone at diagnosis. Primary site outside the extremities (axial: odds ratio,
; others:
), Ewing sarcoma (
), larger tumor size (5–8 cm:
; >8 cm:
), tumor extension beyond the periosteum (
), and regional lymph node metastasis (
) were associated with a higher risk of BM at the initial diagnosis of PMBNs. Five independent prognostic factors were found in the survival analysis: pathological type (chondrosarcoma vs. osteosarcoma: hazard ratio,
; Ewing sarcoma vs. osteosarcoma:
; and chordoma vs. osteosarcoma:
), marital status (
), pulmonary metastasis (
), surgery at the primary site (
), and chemotherapy (
). A nomogram based on these prognostic factors could be a good predictor of cancer-specific survival. Conclusions. We identified the prevalence, risk factors, and prognostic factors correlated with BM in PMBNs patients. The related nomogram could be a practical tool for therapeutic decision-making and individual counseling.
Collapse
|
11
|
Lavit E, Aldea M, Piperno-Neumann S, Firmin N, Italiano A, Isambert N, Kurtz JE, Delcambre C, Lebrun V, Soibinet-Oudot P, Chevreau C, Bompas E, Le Maignan C, Boudou-Rouquette P, Le Cesne A, Mancini J, Blay JY, Duffaud F. Treatment of 120 adult osteosarcoma patients with metachronous and synchronous metastases: A retrospective series of the French Sarcoma Group. Int J Cancer 2021; 150:645-653. [PMID: 34562271 DOI: 10.1002/ijc.33823] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/20/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022]
Abstract
Treatment options for metastatic osteosarcomas are scarce. Following failure of standard first line therapy, patients who relapse present a challenging treatment dilemma, and have a poor prognosis. Surgical removal of all metastases is essential. A retrospective analysis of patients with metastatic osteosarcomas was conducted in 15 French Sarcoma Group centers. From January 2009 to December 2018, we identified 120 adult patients; 36 with synchronous and 84 with metachronous metastases with 74 males and 46 females. Mean age was 30 years (18-53). Metastatic sites were lung, bone and other in 91, 11 and 24 patients, respectively. Mean time to first metachronous metastases was 22 months (4-97). All patients except 13 (10.8%) with metachronous metastases received a first line systemic treatment for relapse, and 39 patients (32.5%) were included in a clinical trial. Eighty-one patients (67.5%) had local treatment of distant metastases. Median progression free survival (PFS) and overall survival (OS) were 5.5 (95% CI 4.6-6.4) and 20.5 months (95% CI 13.2-27.7) respectively for the overall group. In multivariate analysis, more than five metastases, time to first metastases <24 months, were statistically significant negative prognostic factors for OS and PFS (P = .002, ≤.001 and P = .006, ≤.001, respectively). Surgery of metastases was associated with better prognosis on OS and PFS (P = .001 and .037, respectively). The presence of bone metastases was a negative prognostic factor on OS but not on PFS (P = .021). In reference sarcoma centers, relapsed osteosarcoma patients with more than one metastasis commonly receive more than one line of systemic therapy, and are included in clinical trial if available.
Collapse
Affiliation(s)
- Elise Lavit
- Department of Oncology, Hôpital La Timone, Marseille, France
| | | | | | - Nelly Firmin
- Institut du Cancer de Montpellier, Montpellier, France
| | | | | | - Jean-Emmanuel Kurtz
- Department of Onco-Hematology, University Hospital Strasbourg, Strasbourg, France
| | | | - Valérie Lebrun
- Department of Oncology, University Hospital Dupuytren, Limoges, France
| | | | | | | | | | | | | | - Julien Mancini
- Department of Oncology, Hôpital La Timone, Marseille, France.,Aix Marseille University, Inserm, IRD, SESSTIM, Marseille, France
| | | | | |
Collapse
|
12
|
Anderson PM, Scott J, Parsai S, Zahler S, Worley S, Shrikanthan S, Subbiah V, Murphy E. 223-Radium for metastatic osteosarcoma: combination therapy with other agents and external beam radiotherapy. ESMO Open 2021; 5:S2059-7029(20)30059-4. [PMID: 32303572 PMCID: PMC7199915 DOI: 10.1136/esmoopen-2019-000635] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 12/31/2022] Open
Abstract
Background Bone-seeking radiopharmaceuticals can deposit radiation selectively to some osteosarcoma tumours because of the bone-forming nature of this cancer. Objectives This is the first report of using 223-radium, an alpha-emitting calcium analogue with a high therapeutic index, in combination therapy with other agents in 15 patients with metastatic osteoblastic osteosarcoma. Methods Candidates for alpha-radiotherapy if 99mTc-MDP bone scan had avid bone-forming lesions and no therapy of higher priority (eg, definitive surgery). Monthly 223-radium infusions (1.49 μCi/kg or 55.13 kBq/kg) were given. Results The median infusion number was three and the average time to progression was 4.3 months for this cohort receiving 223-radium+other agents. Agents provided during 223-radium included (1) drugs to reduce skeletal complications: monthly denosumab (n=13) or zolendronate (n=1); (2) agents with antivascular endothelial growth factor activity, pazopanib (n=8) or sorafenib (n=1), (3) alkylating agents: oral cyclophosphamide (n=1) or ifosfamide, given as a 14-day continuous infusion (n=1, two cycles), (4) high-dose methotrexate (n=1), pegylated liposomal doxorubicin (n=1); and (5) two other combinations: nivolumab and everolimus (n=1) and rapamycin and auranofin (n=1). Radiation therapy, including stereotactic body radiotherapy (SBRT), was also given to 11 patients concurrently with 223-radium (n=2), after 223-radium completion (n=3), or both concurrently and then sequentially for other sites (n=6). After 223-radium infusions, patients without RT had a median overall survival of 4.3 months compared with those with SBRT and/or RT, who had a median overall survival of 13.5 months. Conclusion Although only 1/15 of patients with osteoblastic osteosarcoma still remain alive after 223-radium, overall survival
Collapse
Affiliation(s)
- Pete M Anderson
- Pediatric Hematology/Oncology/BMT, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jacob Scott
- Radiation Oncology and Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shireen Parsai
- Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stacey Zahler
- Pediatric Hematology/Oncology and BMT, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sarah Worley
- Quantative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Erin Murphy
- Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
13
|
Meazza C, Asaftei SD. State-of-the-art, approved therapeutics for the pharmacological management of osteosarcoma. Expert Opin Pharmacother 2021; 22:1995-2006. [PMID: 34058096 DOI: 10.1080/14656566.2021.1936499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Advances in the treatment of osteosarcoma (OS) came in the mid-1970s, when adding chemotherapy to surgery significantly improved patient survival. OS outcomes have since plateaued, however, despite exhaustive clinical investigations.Area covered: This review focuses on the most significant recent results of trials (in phases II and III) on localized and metastatic/relapsing OS and offers an overview of new targeted drugs.Expert opinion: Recent findings confirm the MAP (methotrexate, doxorubicin, and cisplatin) regimen as the gold standard for OS patients, also in metastatic cases, and the inefficacy of augmenting or modifying chemotherapy in poor responder patients. Immunotherapy and several tyrosine kinase inhibitors seem to be effective and promising in the treatment of OS. Optimizing the use of active drugs available by personalizing chemotherapies might prove important in the future. We urgently need bench-to-bedside research on OS. This will need to involve the extensive sequencing and immunoprofiling of all resected tumor tissue to find new therapeutic agents, especially for relapsing/metastatic patients. The low incidence of OS, its genomic complexity, and differences within and between tumors combine to complicate efforts to elucidate the biology of this disease. This means that we need to pool the resources of different groups studying OS and support translational research.
Collapse
Affiliation(s)
- Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Sebastian Dorin Asaftei
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, AOU Città della Salute e della Scienza di Torino, Ospedale Infantile Regina Margherita, Torino, Italy
| |
Collapse
|
14
|
Kasiram MZ, Hapidin H, Abdullah H, Ahmad A, Sulong S. Combination Therapy of Cisplatin and other Agents for Osteosarcoma: A Review. CURRENT CANCER THERAPY REVIEWS 2021. [DOI: 10.2174/1573394716999201016160946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background:
Osteosarcoma is the most common type of primary bone tumor in children
and adolescents, which is associated with rapid progression and poor prognosis. Multimodal
therapy is the most common approach utilized for osteosarcoma management, such as the application
of chemotherapy in combination with surgery or radiation therapy. Cisplatin is one of the predominantly
used chemotherapeutic agents for osteosarcoma. Optimally, it is employed in combination
with other chemotherapeutic drugs along with surgery or radiation therapy. Despite the availability
of numerous treatment approaches, the patient survival rate has not definitively improved
over the past three decades.
Methods:
We have summarized all findings regarding the combination of cisplatin with other chemotherapeutic
agents as well as with phytochemical compounds.
Results:
A combination of cisplatin with a phytochemical compound synergistically enhances the
killing effect of cisplatin on osteosarcoma cells with fewer side effects compared to combination
with other chemotherapeutic agents.
Conclusion:
Conclusively, a combination of cisplatin with selected chemotherapeutic drugs has
been shown to be effective. However, the unchanged survival rate has posed an urge to search for a
new combination regimen. As a collaborative effort to substantiate the therapeutic efficacy, the
combination with phytochemical compounds shows a promising response both in vitro as well as
in the preclinical study.
Collapse
Affiliation(s)
- Mohamad Z. Kasiram
- School of Health Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Hermizi Hapidin
- School of Health Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Hasmah Abdullah
- School of Health Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Azlina Ahmad
- School of Dental Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Sarina Sulong
- Human Genome Centre, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| |
Collapse
|
15
|
Xu C, Wang M, Guo W, Sun W, Liu Y. Curcumin in Osteosarcoma Therapy: Combining With Immunotherapy, Chemotherapeutics, Bone Tissue Engineering Materials and Potential Synergism With Photodynamic Therapy. Front Oncol 2021; 11:672490. [PMID: 34094974 PMCID: PMC8172965 DOI: 10.3389/fonc.2021.672490] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022] Open
Abstract
Osteosarcoma is a dominating malignant bone tumor with high mortality due to pulmonary metastases. Furthermore, because of the cancer cell erosion and surgery resection, osteosarcoma always causes bone defects, which means dysfunction and disfigurement are seldom inevitable. Although various advanced treatments (e.g. chemotherapy, immunotherapy, radiotherapy) are coming up, the 5-year survival rate for osteosarcoma with metastases is still dismal. In line with this, the more potent treatments for osteosarcoma are in high demand. Curcumin, a perennial herb, has been reportedly applied in the therapy of various types of tumors via different mechanisms. In vitro, it has also been reported that curcumin can inhibit the proliferation of osteosarcoma cell lines and can be used to repair bone defects. This seems curcumin is a promising candidate in osteosarcoma treatment. However, due to its congenital property like hydrophobicity, and low bioavailability, affecting its anticancer effect, clinical applications of curcumin are highly limited. To enhance its performance in cancer therapies, some synergist approaches with curcumin have emerged. The present review presents some prospective ones (i.e. combinations with immunotherapy, chemotherapeutics, bone tissue engineering, and biomaterials) applied in osteosarcoma treatment. Additionally, with the advancements of photodynamic therapy in cancer therapy, this review also prospects the combination of curcumin with photodynamic therapy in osteosarcoma treatment.
Collapse
Affiliation(s)
- Chunfeng Xu
- Section of Restorative and Reconstructive Oral Care, Department of Oral Health Sciences, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mingjie Wang
- Section of Restorative and Reconstructive Oral Care, Department of Oral Health Sciences, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Wei Guo
- Department of Oral-Maxillofacial and Head-Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Sun
- Department of Mechanical Engineering, Drexel University, Philadelphia, PA, United States.,Department of Mechanical Engineering, Tsinghua University, Beijing, China
| | - Yuelian Liu
- Section of Restorative and Reconstructive Oral Care, Department of Oral Health Sciences, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
16
|
Yedururi S, Marcal L, Morani AC, Katabathina VS, Jo N, Rachamallu M, Prasad S. Temporal evolution of metastatic disease: part II-a novel proposal for subcategorization of metastatic disease from non-neural solid tumors with diverse histologies and locations. Jpn J Radiol 2021; 39:844-856. [PMID: 33948787 DOI: 10.1007/s11604-021-01127-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/24/2021] [Indexed: 11/30/2022]
Abstract
Tumor spread is a continuous process and metastases can further disseminate. Currently, metastatic disease from most primary tumors is subcategorized as M0 if absent and M1 if present. However, metastatic disease in different locations may have different prognostic implications, even if it is from the same primary tumor. The current staging systems for metastatic disease have not evolved to match our understanding of the disease's evolution or the evolving treatment paradigms. Primary tumor-specific subcategorization of metastatic disease is currently available for a few tumors, but not all of them imply further remote spread of tumor, similar to tumor (T) and N (node) subcategorizations of the TNM staging, nor are they applicable to wide spectrum of other tumors. In this era of precision medicine, tumor-type agnostic therapies based on common biomarkers rather than primary tumor sites are emerging, but a subcategorization system applicable to metastatic disease from diverse primary tumor locations and with diverse histologies is not available. In this article, we discuss the need to further classify the metastatic disease and present a subcategorization applicable to metastatic disease from non-neural solid tumors from different primary tumor sites and with different histologies, which is based on the temporal spread of metastatic disease. Our proposed subcategorization scheme for metastatic disease into M0, M1, M2 and M3, is universally applicable to a diverse spectrum of non-neural solid tumors, and increasing M subcategorization represents further remote spread of tumor.
Collapse
Affiliation(s)
- Sireesha Yedururi
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Street, Unit 1473, Houston, TX, 77030, USA.
| | - Leonardo Marcal
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Street, Unit 1473, Houston, TX, 77030, USA
| | - Ajaykumar C Morani
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Street, Unit 1473, Houston, TX, 77030, USA
| | - Venkata Subbiah Katabathina
- Department of Radiology, The University of Texas Health Science Center at San Antonio, Floyd Curl Drive, 7703, San Antonio, TX, 78229, USA
| | - Nahyun Jo
- Department of Internal Medicine, UAB Montgomery Regional Medical Campus, 2055 East South Blvd, Ste 200, Montogomery, AL, 36116, USA
| | - Medhini Rachamallu
- Department of Biomedical Engineering, The University of Virginia, 415 Lane Road, MR5 2010, Box 800759, Charlottesville, VA, 22908, USA
| | - Srinivasa Prasad
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Street, Unit 1473, Houston, TX, 77030, USA
| |
Collapse
|
17
|
Xu G, Wu H, Xu Y, Zhang Y, Lin F, Baklaushev VP, Chekhonin VP, Peltzer K, Wang X, Mao M, Wang G, Cui P, Zhang C. Homogenous and Heterogenous Prognostic Factors for Patients with Bone Sarcoma. Orthop Surg 2020; 13:134-144. [PMID: 33305494 PMCID: PMC7862145 DOI: 10.1111/os.12851] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 11/29/2022] Open
Abstract
Objective The aim of this study was to examine the survival rate of patients with different bone sarcomas and to investigate homogenous and heterogenous prognostic factors for different types of bone sarcomas. Methods This is a retrospective analysis of records from the Surveillance, Epidemiology, and End Result (SEER) database. Clear information on the distant metastasis of cancer is provided in the SEER database for patients diagnosed between January 2010 and December 2016. Data for the four types of malignant bone sarcomas were extracted, including osteosarcoma, chondrosarcoma, Ewing sarcoma, and chordoma. Patients with bone sarcomas originated from other sites, diagnosed at autopsy, or indicated in death certification were excluded. The overall survival was calculated for the entire cohort and across different bone sarcomas using the Kaplan–Meier method. A subgroup analysis of the different survival rates of four types of bone sarcomas in various levels of each variable was conducted and the differences were tested with the log‐rank test. Cox proportional hazard regression analysis was performed to determine the prognostic factors. Variables with P < 0.05 in the univariate Cox regression analysis were further analyzed using a multivariate Cox regression analysis. The prognostic factors in four groups of bone sarcomas were compared to determine the homogenous and heterogenous factors. Results A total of 4732 patients were included with a follow up of 25 (0–83) months. The mean age of patients was 39.7 ± 24.1 years. The 1‐year, 3‐year, and 5‐year overall survival rate for the entire cohort was 86.2% (95% confidence interval [CI]: 85.2%–87.2%), 70.5% (95% CI: 68.9%–72.1%), and 63.0% (95% CI: 61.2%–64.8%), respectively. Factors including age older than 40 years, higher grade, regional and distant stage, tumor in the extremities, T2 stage, bone and lung metastases, and non‐surgery were significantly associated with the poor survival of the entire cohort. The mean overall survival duration of patients with chordoma, chondrosarcoma, Ewing sarcoma, and osteosarcoma was 66.86 (95% CI: 64.06–69.66), 63.53 (95% CI: 61.81–65.25), 58.06 (95% CI: 55.49–60.62) and 54.91 (95% CI: 53.14–56.69) months, respectively. Compared with chordoma, the hazard ratio (HR) and 95% CI for patients with chondrosarcoma, Ewing sarcoma, and osteosarcoma were 1.30 (95% CI: 1.04–1.62; P = 0.023), 1.69 (95% CI: 1.33–2.14; P < 0.001), and 2.00 (95% CI: 1.61–2.48; P <0.001), respectively. Different bone sarcomas showed homogenous and heterogenous prognostic factors. Conclusion Different clinicopathological characteristics and prognoses were revealed in patients with osteosarcoma, chondrosarcoma, Ewing sarcoma, and chordoma. The risk factors can potentially guide prognostic prediction and sarcoma‐specific treatment.
Collapse
Affiliation(s)
- Guijun Xu
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China.,Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Haixiao Wu
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yao Xu
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yanting Zhang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Feng Lin
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Vladimir P Baklaushev
- Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency of the Russian Federation, Moscow, Russian Federation
| | - Vladimir P Chekhonin
- Department of Basic and Applied Neurobiology, Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russian Federation
| | - Karl Peltzer
- Department of Research and Innovation, University of Limpopo, Turfloop, South Africa
| | - Xin Wang
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Min Mao
- Department of Pathology, First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Guowen Wang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Ping Cui
- Department of Public Health, Jining Medical University, Jining, China
| | - Chao Zhang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| |
Collapse
|
18
|
Jeddo SFA, Wei X, Li K, Li X, Yang Q, Dongol S, Li J. Maternal embryonic leucine zipper kinase serves as a poor prognosis marker and therapeutic target in osteosarcoma. Oncol Rep 2020; 44:1037-1048. [PMID: 32705239 PMCID: PMC7388486 DOI: 10.3892/or.2020.7686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/10/2020] [Indexed: 12/18/2022] Open
Abstract
Osteosarcoma is the most common primary malignancy of bones and frequently affects young children and adolescents. There are several challenges associated with treating osteosarcoma owing to the aggressiveness of the disease, as well as the risk of chemoresistance. Numerous studies are being performed with the aim of identifying improved prognostic and therapeutic markers for this malignancy. Maternal embryonic leucine zipper kinase (MELK) is an oncogene that has been studied in several types of cancer in recent years. In the present study, the expression of MELK in osteosarcoma and normal tissue samples was examined, and the effects of MELK expression on osteosarcoma cellular proliferation, metastasis, the cell cycle and apoptosis were demonstrated using CCK-8, wound healing, migration and invasion and apoptosis assays. The role of MELK in cancer progression in osteosarcoma was determined, revealing the association between MELK expression and prognosis of osteosarcoma. It was demonstrated that knockdown of MELK resulted in reduced proliferation, migration and invasion in vitro along with potentiation of apoptosis and cell cycle arrest. Furthermore, the effect of the targeted MELK inhibitor, OTSSP167, on tumor progression of osteosarcoma in vitro and in vivo was assessed. Mechanistically, it was demonstrated that MELK promoted osteosarcoma proliferation and metastasis by regulating PCNA and MMP9 expression via the PI3K/Akt/mTOR signaling pathway. Thus, the present study revealed the oncogenic role played by MELK, and established MELK as a valuable prognostic and therapeutic marker in osteosarcoma.
Collapse
Affiliation(s)
- Salim F A Jeddo
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xianfu Wei
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Ka Li
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xin Li
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Qiang Yang
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Samina Dongol
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Jianmin Li
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| |
Collapse
|
19
|
Pushpam D, Garg V, Ganguly S, Biswas B. Management of Refractory Pediatric Sarcoma: Current Challenges and Future Prospects. Onco Targets Ther 2020; 13:5093-5112. [PMID: 32606731 PMCID: PMC7293381 DOI: 10.2147/ott.s193363] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022] Open
Abstract
Paediatric sarcomas are a heterogeneous group of disorders constituting bone sarcoma and various soft tissue sarcomas. Almost one-third of these presents with metastasis at baseline and another one-third recur after initial curative treatment. There is a huge unmet need in this cohort in terms of curative options and/or prolongation of survival. In this review, we have discussed the current treatment options, challenges and future strategies of managing relapsed/refractory paediatric sarcomas. Upfront risk-adapted treatment with multidisciplinary management remains the main strategy to prevent future recurrence or relapse of the disease. In the case of limited local and/or systemic relapse or late relapse, initial multimodality management can be administered. In treatment-refractory cases or where cure is not feasible, the treatment options are limited to novel therapeutics, immunotherapeutic approach, targeted therapies, and metronomic therapies. A better understanding of disease biology, mechanism of treatment refractoriness, identifications of driver mutation, the discovery of novel targeted therapies, cellular vaccine and adapted therapies should be explored in relapsed/refractory cases. Close national and international collaboration for translation research is needed to fulfil the unmet need.
Collapse
Affiliation(s)
| | - Vikas Garg
- Department of Medical Oncology, AIIMS, New Delhi, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| |
Collapse
|
20
|
Meazza C, Bastoni S, Scanagatta P. What is the best clinical approach to recurrent/refractory osteosarcoma? Expert Rev Anticancer Ther 2020; 20:415-428. [PMID: 32379504 DOI: 10.1080/14737140.2020.1760848] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Osteosarcoma is the most common malignant bone tumor. It is currently treated with pre-and postoperative chemotherapy, associated with surgical resection of the tumor.Area covered: Relapses occur in about one in three patients presenting with localized disease, and three in four of those with metastases at diagnosis. Relapsing disease carries a very poor prognosis, with 5-year survival rates ranging between 13% and 40%.Expert opinion: Patients with unilateral lung involvement or solitary lung metastases and a recurrence-free interval (RFI) longer than 24 months have a better prognosis, and could be managed with surgical resection and close observation. Complete surgical resection of all sites of disease remains essential to survival: patients unable to achieve complete remission have a catastrophic overall survival rate. The role of second-line chemotherapy is not at all clear, and no controlled studies are available on this topic. It is worth considering for patients unable to achieve complete surgical remission, and those with multiple metastases and/or a RFI <24 months. Given their dismal prognosis, patients with multiple sites of disease not amenable to complete surgical resection should also be considered for innovative therapeutic approaches.
Collapse
Affiliation(s)
- Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Stefano Bastoni
- Center for Oncological Orthopedic Surgery, ASST Azienda Ospedaliera Istituto G Pini-CTO, Milano, Italy
| | - Paolo Scanagatta
- Thoracic Surgery Division, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| |
Collapse
|
21
|
Hypoxia-Inducible Factor 1A Upregulates HMGN5 by Increasing the Expression of GATA1 and Plays a Role in Osteosarcoma Metastasis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5630124. [PMID: 31930127 PMCID: PMC6942741 DOI: 10.1155/2019/5630124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/10/2019] [Indexed: 11/17/2022]
Abstract
Osteosarcoma is one of the most common malignant tumors in children and adolescents and is characterized by early metastasis. High-mobility group N (HMGN) domains are involved in the development of several tumors. Our previous study found that HMGN5 is highly expressed in osteosarcoma tissues and knockdown of HMGN5 inhibits migration and invasion of U-2 OS and Saos-2 cells. A hypoxic environment is commonly found in solid tumors such as osteosarcoma and is likely to be associated with tumor metastasis, so we further explored the relationship between HMGN5 and the hypoxic environment. Hypoxia-inducible factor 1A (HIF1A) is an adaptive factor in the hypoxic environment. We found that HIF1A and HMGN5 were upregulated in osteosarcoma (OS) cells cultured in the hypoxic environment, and the results of overexpression and knockdown experiments showed that HIF1A upregulated the transcription factor GATA1 and further promoted the expression of HMGN5. In addition, MMP2 and MMP9 were subsequently upregulated through the c-jun pathway, and finally, this promoted the migration and invasion of OS cells. It is suggested that HMGN5 may be an important downstream factor for HIF1A to promote osteosarcoma metastasis. It has an important clinical significance for the selection of therapeutic targets for osteosarcoma.
Collapse
|
22
|
Liu F, Zhang Q, Zhou D, Dong J. Effectiveness of 18F-FDG PET/CT in the diagnosis and staging of osteosarcoma: a meta-analysis of 26 studies. BMC Cancer 2019; 19:323. [PMID: 30953476 PMCID: PMC6451259 DOI: 10.1186/s12885-019-5488-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/19/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Multiple trials have attempted to assess the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in osteosarcoma with results remaining inconclusive. This study aims to investigate the effectiveness of 18F-FDG PET and PET/CT in the diagnosis, staging, recurrence and metastasis formation observations of osteosarcoma through systematic review followed by meta-analysis. METHODS Three electronic databases, Medline/PubMed, Embase and the Cochrane Library were utilized in this study. Eligible studies that assessed the performance of 18F-FDG PET/CT for the diagnosis, staging, restaging and recurrence monitoring of osteosarcoma were retrieved utilizing specific search criteria. After screening and diluting out the non-conforming articles, all relevant articles and their data were identified and extracted to calculate the summary metrics involving sensitivity, specificity, diagnostic odd ratio (DOR), and area under the curve (AUC) to determine the effectiveness of 18F-FDG PET in diagnosing osteosarcoma clinically. RESULTS Out of 1976 articles searched, twenty-six studies were identified that were viable. All data from these articles, utilized in the quantitative analyses, showed after meta-analysis that when utilizing 18F-FDG PET or PET/CT it was better with a success rate of 90-100% for detecting primary lesions and distant metastases of patients with osteosarcoma. Similar results were also obtained for detecting lung and bone metastases in a subgroup analysis. CONCLUSIONS As such the investigation demonstrated that 18F-FDG PET and PET/CT are very accurate for the diagnosis, staging and recurrence monitoring of osteosarcoma. 18F-FDG-avid lesions should be further examined in osteosarcoma, especially for suspicious lung lesions.
Collapse
Affiliation(s)
- Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021 Shandong China
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistrasse 23, 81377 Munich, Germany
| | - Qingyu Zhang
- Department of Orthopeadics, Qilu Hospital, Shandong University, Jinan, Shandong China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021 Shandong China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021 Shandong China
| |
Collapse
|
23
|
Xu J, Guo W, Xie L. Combination of gemcitabine and docetaxel: a regimen overestimated in refractory metastatic osteosarcoma? BMC Cancer 2018; 18:987. [PMID: 30326879 PMCID: PMC6192345 DOI: 10.1186/s12885-018-4872-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 09/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background The combination of gemcitabine and docetaxel (GT) has been demonstrated to be effective against various types of solid tumors, including sarcoma. However, the regimen has not been confirmed in large, well-designed clinical trials in refractory metastatic osteosarcoma. Methods We retrospectively reviewed the records of patients with refractory metastatic osteosarcoma at Peking University People’s Hospital who were treated with gemcitabine (1000 mg/m2) intravenously (IV) on Day 1 and Day 8, and docetaxel (75 mg/m2) IV on Day 8, repeated every 21 days. Results A total of 52 patients with a median age of 18.4 years were treated with GT at the Peking University People’s Hospital from August 2012 to August 2017. A total of 174 courses were administered. Only five patients with pulmonary metastasis achieved a best response of stable disease (SD), while all other patients had progressive disease. The result was disappointing with an ORR of 0%, a DCR of 9.6%, and a median DOR of 3.5 months. Grade 3 or 4 toxicities were observed in 69 (39.7%) courses and in 28 (53.8%) patients, most of which were myelosuppression, especially thrombocytopenia. No fatal adverse effect (AE) was found. Conclusion The combination of gemcitabine and docetaxel (GT) as a salvage regimen is well-tolerated but not as effective as expected in refractory metastatic osteosarcoma. This report highlights the need for the development of new approaches with higher activity in these patients.
Collapse
Affiliation(s)
- Jie Xu
- Musculoskeletal Tumor Center, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, China.
| | - Lu Xie
- Musculoskeletal Tumor Center, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, China
| |
Collapse
|
24
|
Zhao YX, Gao ST, Wang JQ, Yao WT, Wang YS, Guo CL. Correlations Between Hector Battifora Mesothelial-1 (HBME-1) Expression and Clinical Pathological Characteristics and Prognosis of Osteosarcoma Patients. Med Sci Monit 2017; 23:665-672. [PMID: 28163298 PMCID: PMC5310229 DOI: 10.12659/msm.898820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The aim of this study was to investigate the correlation between Hector Battifora mesothelial-1 (HBME-1) expression and the clinical pathological characteristics and prognosis of osteosarcoma (OS). Material/Methods HBME-1 expression was assessed using immunohistochemistry in OS tissues (n=152), osteochondroma tissues (n=91), and normal bone tissues (n=74). We carried out a follow-up lasting 8–60 months to investigate HBME-1 expression and its correlations with the clinical pathological characteristics and prognosis of OS. Results HBME-1 was highly expressed in OS tissues compared with osteochondroma tissues and normal bone tissues, and was highly expressed in osteochondroma tissues compared with normal bone tissues (all P<0.05). HBME-1 expression was correlated with clinical stages, postoperative recurrence, metastasis, and 5-year survival (all P<0.05). The area under the receiver operating characteristics curve of HBME-1 expression was 0.864, with sensitivity of 80.92%, specificity of 91.89%, and accuracy of 84.51%. The survival rate was lower in the HBME-1 positive expression group than the HBME-1 negative expression group (P<0.05). Clinical stages, metastasis, and HBME-1 expression were independent risk factors for the survival of patients with OS (all P<0.05). Conclusions HBME-1 expression was correlated with the occurrence and development of OS. HBME-1 positive expression was a risk factor for the prognosis of OS.
Collapse
Affiliation(s)
- Yu-Xin Zhao
- Department of Bone and Soft Tumors, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China (mainland)
| | - Song-Tao Gao
- Department of Bone and Soft Tumors, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China (mainland)
| | - Jia-Qiang Wang
- Department of Bone and Soft Tumors, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China (mainland)
| | - Wei-Tao Yao
- Department of Bone and Soft Tumors, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China (mainland)
| | - Yi-Sheng Wang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Cai-Li Guo
- Department of Respiratory Medicine, Children's Hospital of Zhengzhou City, Zhengzhou, Henan, China (mainland)
| |
Collapse
|
25
|
Wang Z, Zhang K, Zhu Y, Wang D, Shao Y, Zhang J. Curcumin inhibits hypoxia-induced proliferation and invasion of MG-63 osteosarcoma cells via downregulating Notch1. Mol Med Rep 2017; 15:1747-1752. [PMID: 28138706 DOI: 10.3892/mmr.2017.6159] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 11/11/2016] [Indexed: 11/05/2022] Open
Abstract
Curcumin is a biologically active ingredient abundantly present in the ground rhizomes of Curcuma longa with a wide range of bioactive properties, including antitumor effects. Hypoxia is a common characteristic of solid tumors, including osteosarcoma. However, whether curcumin has antitumor effects on osteosarcoma under hypoxic conditions, and its underlying molecular mechanisms, remain unclear. The present study demonstrated that the MG‑63 osteosarcoma cell line exhibited increased proliferation and enhanced invasiveness upon exposure to hypoxic conditions. However, these effects were prevented by curcumin treatment. Further investigation revealed that curcumin may inhibit Notch1 upregulation induced by hypoxia. Overexpression of Notch1 via Notch1 cDNA transfection ameliorated curcumin‑inhibited MG‑63 cell growth under hypoxic conditions. Taken together, these data revealed that curcumin may suppress the growth of osteosarcoma cells in hypoxia via inhibiting Notch1 signaling.
Collapse
Affiliation(s)
- Zhan Wang
- Department of Orthopaedics, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710054, P.R. China
| | - Kun Zhang
- Department of Orthopaedics, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710054, P.R. China
| | - Yangjun Zhu
- Department of Orthopaedics, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710054, P.R. China
| | - Dengfeng Wang
- Department of Orthopaedics, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710054, P.R. China
| | - Yuxiong Shao
- Department of Orthopaedics, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710054, P.R. China
| | - Jun Zhang
- Department of Orthopaedics, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710054, P.R. China
| |
Collapse
|
26
|
Abstract
Osteosarcoma (OS) is the most common primary malignancy of bone and patients with metastatic disease or recurrences continue to have very poor outcomes. Unfortunately, little prognostic improvement has been generated from the last 20 years of research and a new perspective is warranted. OS is extremely heterogeneous in both its origins and manifestations. Although multiple associations have been made between the development of osteosarcoma and race, gender, age, various genomic alterations, and exposure situations among others, the etiology remains unclear and controversial. Noninvasive diagnostic methods include serum markers like alkaline phosphatase and a growing variety of imaging techniques including X-ray, computed tomography, magnetic resonance imaging, and positron emission as well as combinations thereof. Still, biopsy and microscopic examination are required to confirm the diagnosis and carry additional prognostic implications such as subtype classification and histological response to neoadjuvant chemotherapy. The current standard of care combines surgical and chemotherapeutic techniques, with a multitude of experimental biologics and small molecules currently in development and some in clinical trial phases. In this review, in addition to summarizing the current understanding of OS etiology, diagnostic methods, and the current standard of care, our group describes various experimental therapeutics and provides evidence to encourage a potential paradigm shift toward the introduction of immunomodulation, which may offer a more comprehensive approach to battling cancer pleomorphism.
Collapse
Affiliation(s)
- Brock A Lindsey
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA.
| | - Justin E Markel
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | | |
Collapse
|
27
|
Abstract
Osteosarcoma is the most common primary malignancy of bone in children and young adults. This tumor has a very heterogeneous genetic profile and lacks any consistent unifying event that leads to the pathogenesis of osteosarcoma. In this review, some of the important genetic events involved in osteosarcoma will be highlighted. Additionally, the clinical diagnosis of osteosarcoma will be discussed, as well as contemporary chemotherapeutic and surgical management of this tumor. Finally, the review will discuss some of the novel approaches to treating this disease.
Collapse
Affiliation(s)
- Ryan A Durfee
- Department of Orthopaedic Surgery and Rehabilitation, University of Chicago, Chicago, IL, USA
| | - Maryam Mohammed
- Department of Orthopaedic Surgery and Rehabilitation, University of Chicago, Chicago, IL, USA
| | - Hue H Luu
- Department of Orthopaedic Surgery and Rehabilitation, University of Chicago, Chicago, IL, USA.
| |
Collapse
|
28
|
Meazza C, Scanagatta P. Metastatic osteosarcoma: a challenging multidisciplinary treatment. Expert Rev Anticancer Ther 2016; 16:543-56. [PMID: 26999418 DOI: 10.1586/14737140.2016.1168697] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Osteosarcoma is the most common malignant bone tumor, currently treated with pre-and postoperative chemotherapy in association with the surgical removal of the tumor. About 15-20% of patients have evidence of metastases at diagnosis, mostly in the lungs. Patients with metastatic disease still have a very poor prognosis, with approximately 20-30% of long-term survivors, as compared with 65-70% of patients with localized disease. The optimum management of these patients has not been standardized yet due to several patterns of metastatic disease harboring different prognosis. Complete surgical resection of all sites of disease is mandatory and predictive of survival. Patients with multiple sites of disease not amenable to complete surgery removal should be considered for innovative therapeutic approaches because of poor prognosis.
Collapse
Affiliation(s)
- Cristina Meazza
- a Pediatric Oncology Unit , Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Paolo Scanagatta
- b Division of Thoracic Surgery , Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| |
Collapse
|
29
|
Marais LC, Bertie J, Rodseth R, Sartorius B, Ferreira N. Pre-treatment serum lactate dehydrogenase and alkaline phosphatase as predictors of metastases in extremity osteosarcoma. J Bone Oncol 2015; 4:80-4. [PMID: 26587373 PMCID: PMC4648997 DOI: 10.1016/j.jbo.2015.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/01/2015] [Accepted: 09/24/2015] [Indexed: 11/15/2022] Open
Abstract
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. METHODS Sixty-one patients with histologically confirmed conventional osteosarcoma of the extremity were included in the study. Only 19.7% of cases presented without evidence of systemic spread of the disease. Pre-treatment serum ALP and LDH were analysed in patients with and without skeletal or pulmonary metastases. RESULTS Serum LDH and ALP levels were not significantly different in patients with or without pulmonary metastases (p=0.88 and p=0.47, respectively). The serum LDH and ALP levels did however differ significantly in patients with or without skeletal metastases (p<0.001 and p=0.02, respectively). The optimal breakpoint for serum LDH as a marker of skeletal metastases was 849 IU/L (AUC 0.839; Sensitivity=0.88; Specificity=0.73). LDH >454 IU/L equated to 100% sensitivity for detected bone metastases (positive diagnostic likelihood ratio (DLR)=1.32). With a cut-off of 76 IU/L a sensitivity of 100% was reached for serum ALP predicting the presence of skeletal metastases (positive DLR=1.1). In a multivariate analysis both LDH ≥850 IU/L (odds ratio [OR]=9; 95% confidence interval (CI) 1.8-44.3) and ALP ≥280 IU/L (OR=10.3; 95% CI 2.1-50.5) were predictive of skeletal metastases. LDH however lost its significance in a multivariate model which included pre-treatment tumour volume. CONCLUSION In cases of osteosarcoma with LDH >850 IU/L and/or ALP >280 IU/L it may be prudent to consider more sensitive staging investigations for detection of skeletal metastases. Further research is required to determine the value and the most sensitive cut-off points of serum ALP and LDH in the prediction of skeletal metastases.
Collapse
Key Words
- ALP, alkaline phosphatase
- AUC, area under curve
- Alkaline phosphatase
- CI, confidence interval
- CT, computed tomography
- DLR, diagnostic likelihood ratio
- ESMO, European Society of Medical Oncology
- FDG-PET, 18F-fluorodeoxy-D-glucose positron emission tomography
- LDH, lactate dehydrogenase
- Lactate dehydrogenase
- MRI, magnetic resonance imaging
- Metastases
- OR, odds ratio
- Osteosarcoma
- Prognosis
- ROC, Receiver operating characteristic
- SD, standard deviation
- SEER, Surveilance, Epidemiology and End Results
- Staging
Collapse
Affiliation(s)
- Leonard C Marais
- Tumor, Sepsis and Reconstruction Unit, Department of Orthopaedic Surgery, Greys Hospital, School of Clinical Medicine, University of KwaZulu-Natal, South Africa
| | - Julia Bertie
- Department of Orthopaedic Surgery, Edendale Hospital, School of Clinical Medicine, University of KwaZulu-Natal, South Africa
| | - Reitze Rodseth
- Perioperative Research Group, Department of Anaesthetics, Grey's Hospital, School of Clinical Medicine, University of KwaZulu-Natal, South Africa
| | - Benn Sartorius
- Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
| | - Nando Ferreira
- Tumor, Sepsis and Reconstruction Unit, Department of Orthopaedic Surgery, Greys Hospital, School of Clinical Medicine, University of KwaZulu-Natal, South Africa
| |
Collapse
|
30
|
Abstract
PURPOSE OF REVIEW Survival rates for children with metastatic sarcoma have remained dismal despite intensified multiagent chemotherapy protocols. The local treatment of metastatic disease has been promoted as a way to eliminate colonies of genetically unstable, heterogeneous metastatic cells in an attempt to improve survival amongst this most unfortunate patient population. RECENT FINDINGS The survival benefit offered by pulmonary metastasectomies in patients with metastatic osteosarcoma is well substantiated. Utilization of other local treatment modalities, such as radiation therapy and percutaneous thermal ablation, offers the opportunity to intervene in a wide range of pulmonary and extrapulmonary metastatic disease. Patients who have the entirety of their identifiable disease addressed by local control modalities consistently demonstrate improved survival compared with patients who are treated with systemic therapy in isolation. SUMMARY The current state of the literature prevents a definitive conclusion about the utility of local control for metastatic sarcoma. The retrospective trials are clouded by selection bias and the prospective studies are designed to address alternative questions. However, the techniques utilized for local control impart minimal risk to the patient and, in amenable cases, have been shown to provide an opportunity to effect a cure in children with an otherwise dismal prognosis.
Collapse
|
31
|
Three Metachronous Osteosarcomas within 22 Years without Pulmonary Metastases: A Case Report and Review of the Literature. Case Rep Orthop 2014; 2013:197287. [PMID: 24455368 PMCID: PMC3886224 DOI: 10.1155/2013/197287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 11/21/2013] [Indexed: 11/21/2022] Open
Abstract
Introduction. We present the extremely rare case of a patient with three metachronous osteosarcomas within 22 years without evident pulmonary manifestation of disease 30 years after first diagnosis. Case Presentation. In 1983, a high-grade osteosarcoma of the left distal femur was diagnosed in an 18-year-old Caucasian male. He received rotationplasty accompanied by pre- and postoperative chemotherapy. Ten years later, an osteoblastic osteosarcoma occurred in TH12. En bloc resection and pre- and postoperative chemotherapy followed. In 2005, the patient developed another high-grade osteosarcoma in his right distal femur. Treatment included a wide resection and reconstruction with a tumour endoprosthesis as well as (neo)adjuvant chemotherapy. After the third tumour occurrence, cytogenetic and molecular genetic examinations (p53, rb1) were performed, showing a normal genetic pattern. Screening for metastases never showed clinical evidence of extraskeletal tumour manifestation. Discussion. In patients presenting metachronous osteosarcoma, identification of their lesions clonality (second primary tumour or metastases) could lead to a better understanding of tumour development and help to filter patients who need extended long-term followup due to a higher risk of late occurring sarcoma recurrence.
Collapse
|
32
|
Errani C, Longhi A, Rossi G, Rimondi E, Biazzo A, Toscano A, Alì N, Ruggieri P, Alberghini M, Picci P, Bacci G, Mercuri M. Palliative therapy for osteosarcoma. Expert Rev Anticancer Ther 2014; 11:217-27. [DOI: 10.1586/era.10.172] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
33
|
Comparison of (18)F-FDG PET/CT and (99 m)Tc-MDP bone scintigraphy for detection of bone metastasis in osteosarcoma. Skeletal Radiol 2013; 42:1673-81. [PMID: 23995264 DOI: 10.1007/s00256-013-1714-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 07/10/2013] [Accepted: 08/08/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We compared the diagnostic performance of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and (99 m)Tc-methylene diphosphonate bone scintigraphy (BS) for the detection of bone metastasis in osteosarcoma. MATERIALS AND METHODS We retrospectively reviewed 206 patients with stage II-IV osteosarcoma treated with surgery and chemotherapy as well as at least one paired PET/CT and BS scan (defined as an examination). PET/CT and BS images were interpreted separately. When analyzing the diagnostic yield of a combination of PET/CT and BS (PET/CT+BS), an examination was considered positive if either PET/CT or BS scored positive. The final diagnosis was obtained from histological findings or clinical follow-up with imaging studies for at least 6 months. Diagnostic performances of PET/CT, BS, and their combinations were calculated. RESULTS Out of 833 examinations in 206 patients, 55 with 101 lesions in 38 patients were confirmed as bone metastases. The sensitivity, specificity, and diagnostic accuracy were 95, 98, and 98%, respectively, for PET/CT; 76, 97, and 96%, respectively, for BS; and 100, 96, and 97%, respectively, for PET/CT+BS in an examination-based analysis. Lesion-based analysis demonstrated that the sensitivity of PET/CT+BS (100%) was significantly higher than that of PET/CT (92%) or BS (74%) alone. BS detected significantly less bone metastases in the growth plate region than outside the growth plate region (22 vs. 77%). CONCLUSIONS PET/CT is more sensitive and accurate than BS for diagnosing bone metastases in osteosarcoma. The combined use of PET/CT and BS improves sensitivity.
Collapse
|
34
|
Luetke A, Meyers PA, Lewis I, Juergens H. Osteosarcoma treatment - where do we stand? A state of the art review. Cancer Treat Rev 2013; 40:523-32. [PMID: 24345772 DOI: 10.1016/j.ctrv.2013.11.006] [Citation(s) in RCA: 901] [Impact Index Per Article: 81.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 11/14/2013] [Accepted: 11/18/2013] [Indexed: 12/01/2022]
Abstract
Long-term outcome for patients with high-grade osteosarcoma has improved with the addition of systemic chemotherapy, but subsequent progress has been less marked. Modern, multiagent, dose-intensive chemotherapy in conjunction with surgery achieves a 5-year event-free survival of 60-70% in extremity localized, non-metastatic disease. A major, as yet unsolved, problem is the poor prognosis for metastatic relapse or recurrence, and for patients with axial disease. This article reviews the current state of the art of systemic osteosarcoma therapy by focusing on the experiences of cooperative osteosarcoma groups. Also, we shed light on questions and challenges posed by the aggressiveness of the tumor, and we consider potential future directions that may be critical to progress in the prognosis of high-grade osteosarcoma.
Collapse
Affiliation(s)
- Anja Luetke
- Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Paul A Meyers
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Ian Lewis
- Alder Hey Children's NHS FT, Liverpool, United Kingdom
| | - Heribert Juergens
- Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany.
| |
Collapse
|
35
|
Vijayamurugan N, Bakhshi S. Review of management issues in relapsed osteosarcoma. Expert Rev Anticancer Ther 2013; 14:151-61. [PMID: 24308680 DOI: 10.1586/14737140.2014.863453] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. With combined modality treatment long-term survival rate for localized disease is near 70%. Thirty percent of patients relapse with lung as the commonest site. Surgery is the treatment of choice for relapsed patients whenever possible. Addition of chemotherapy to surgery provides survival benefit in patients not achieving second surgical remission. Even patients with multiple lung recurrences can be cured with repeated thoracotomies. Disease-free interval and complete surgical resection are the main prognostic factor for post-relapse survival.
Collapse
Affiliation(s)
- Nataraj Vijayamurugan
- Departments of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi-110029, India
| | | |
Collapse
|
36
|
Kim SM, Lee H, Park YS, Lee Y, Seo SW. ERK5 regulates invasiveness of osteosarcoma by inducing MMP-9. J Orthop Res 2012; 30:1040-4. [PMID: 22213073 DOI: 10.1002/jor.22025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 11/08/2011] [Indexed: 02/04/2023]
Abstract
The purpose of this study is to determine the role of ERK5 in cellular invasion of osteosarcoma (OS). The human OS cell line (MG63, SaOS, and U2OS) and primary OS cells were used for the study. The expression of ERK5 and MMP-9 in each cell was examined by western blot or RT-PCR. To evaluate the biological role of ERK5, proliferation assay (MTT) and invasion assay (BD Matrigel™) were performed after silencing ERK5 using siRNA. MMPs expressions were analyzed using RT-PCR and zymography after silencing ERK5. ERK5 was distinctly overexpressed in U2OS and primary OS cell. Both of them also expressed MMP-9, which was not shown in MG63 and SaOS in RT-PCR. ERK5 silencing did not suppress the proliferation of OS cells. However, ERK5 silencing significantly reduced the number of invading cells in invasion assay. The expression of MMP-9 was specifically reduced after silencing ERK5. The zymography showed that the enzyme activity of MMP-9 was also reduced after ERK5 suppression. The expression of ERK5 regulates the invasion of OS cells by inducing MMP-9 expression. Therefore, ERK5 may be a new therapeutic target in invasive OS expressing MMP-9.
Collapse
Affiliation(s)
- Sang-Min Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Seoul 135-710, Korea
| | | | | | | | | |
Collapse
|
37
|
Berger M, Grignani G, Giostra A, Ferrari S, Ferraresi V, Tamburini A, Cefalo G, Carnevale-Schianca F, Vassallo E, Picci P, Pagano M, Aglietta M, Pellerito R, Fagioli F. 153Samarium-EDTMP administration followed by hematopoietic stem cell support for bone metastases in osteosarcoma patients. Ann Oncol 2012; 23:1899-905. [DOI: 10.1093/annonc/mdr542] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
38
|
Franke M, Hardes J, Helmke K, Jundt G, Jürgens H, Kempf-Bielack B, Kevric M, Tunn PU, Werner M, Bielack S. Solitary skeletal osteosarcoma recurrence. Findings from the Cooperative Osteosarcoma Study Group. Pediatr Blood Cancer 2011; 56:771-6. [PMID: 21370409 DOI: 10.1002/pbc.22864] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 09/14/2010] [Indexed: 11/08/2022]
Abstract
BACKGROUND Solitary skeletal osteosarcoma (OS) manifestations distant from the site of the primary tumor rarely arise as only sign of disease recurrence. METHODS This report reviews 38 patients with high-grade central OS of the limbs or axial skeleton and initial complete surgical remission (CR) who developed first recurrences as solitary osseous lesions distant from the primary tumor. The Cooperative Osteosarcoma Study Group (COSS) database was used to evaluate patient-, tumor-, and treatment-related variables and outcomes. RESULTS Thirty-eight patients (27 males and 11 females; 36 limb and 2 axial primaries) developed solitary osseous recurrences a median of 2.1 years (range: 0.5-14.3) from primary diagnosis. Relapses involved axial (24), extremity (10), or craniofacial bones (4). Treatment for recurrence included surgery (28), radiotherapy (10), and chemotherapy (27). After a median follow-up of 1.9 years (range: 0.1-21.2) from first recurrence for all 38 patients and 5.5 years (0.3-21.2) for 16 survivors (10 in continuous second CR), 2- and 5-year overall and event-free survival (EFS) probabilities were 55% and 34% and 34% and 27%, respectively. A long interval to recurrence (>1.5 years) predicted for better overall (P < 0.001) and EFS (P = 0.005). For 21 patients achieving a second CR, 2- and 5-year overall and EFS probabilities were 81% and 61% and 52% and 49%, respectively, while only 1/17 others survived beyond 5 years (P < 0.001). Survivors (14/16) had also received second-line chemotherapy. CONCLUSION First solitary skeletal recurrences of OS should be treated with curative intent. Some presumed bone metastases may represent second primary OSs.
Collapse
Affiliation(s)
- Markus Franke
- Klinikum Stuttgart-Olgahospital, Department of Pediatric Surgery, Stuttgart, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Sewell MD, Spiegelberg BGI, Hanna SA, Aston WJS, Bartlett W, Blunn GW, David LA, Cannon SR, Briggs TWR. Total femoral endoprosthetic replacement following excision of bone tumours. ACTA ACUST UNITED AC 2009; 91:1513-20. [PMID: 19880899 DOI: 10.1302/0301-620x.91b11.21996] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We undertook a retrospective review of 33 patients who underwent total femoral endoprosthetic replacement as limb salvage following excision of a malignant bone tumour. In 22 patients this was performed as a primary procedure following total femoral resection for malignant disease. Revision to a total femoral replacement was required in 11 patients following failed segmental endoprosthetic or allograft reconstruction. There were 33 patients with primary malignant tumours, and three had metastatic lesions. The mean age of the patients was 31 years (5 to 68). The mean follow-up was 4.2 years (9 months to 16.4 years). At five years the survival of the implants was 100%, with removal as the endpoint and 56% where the endpoint was another surgical intervention. At five years the patient survival was 32%. Complications included dislocation of the hip in six patients (18%), local recurrence in three (9%), peri-prosthetic fracture in two and infection in one. One patient subsequently developed pulmonary metastases. There were no cases of aseptic loosening or amputation. Four patients required a change of bushings. The mean Musculoskeletal Tumour Society functional outcome score was 67%, the mean Harris Hip Score was 70, and the mean Oxford Knee Score was 34. Total femoral endoprosthetic replacement can provide good functional outcome without compromising patient survival, and in selected cases provides an effective alternative to amputation.
Collapse
Affiliation(s)
- M D Sewell
- Institute of Orthopaedics and Musculoskeletal Science, The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Rastogi R, Garg R, Thulkar S, Bakhshi S, Gupta A. Unusual thoracic CT manifestations of osteosarcoma: review of 16 cases. Pediatr Radiol 2008; 38:551-8. [PMID: 18246342 DOI: 10.1007/s00247-007-0735-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2007] [Revised: 11/25/2007] [Accepted: 12/13/2007] [Indexed: 11/30/2022]
Abstract
Pulmonary metastases are common in osteosarcoma and the most common appearance is of multiple well-defined nodules in the lung parenchyma. However, a variety of atypical locations and presentations of osteosarcoma metastasis can occur in the thorax. We present a review of the thoracic CT findings in 16 patients with histopathologically confirmed osteosarcoma with unusual thoracic manifestations. The 16 patients were selected out of a total 136 patients who received a chest CT scan for osteosarcoma during a period of 3 years in a tertiary care hospital. Unusual imaging findings included a solitary large ossified lung mass, ossified mediastinal and hilar lymph nodes, an esophagomediastinal fistula, lymphangitic carcinomatosis, pulmonary artery tumor emboli, a solitary large pleural deposit along the major fissure, multiple pleural deposits, diffuse pleural calcification, pneumothorax, diaphragmatic deposits, an isolated chest wall deposit without lung involvement, and primary osteosarcoma of the rib. Our findings of lymphangitic carcinomatosis in a living patient as well as calcified mediastinal lymphadenopathy leading to esophageal fistula are unique in the literature, and there are only a few case reports of our other findings.
Collapse
Affiliation(s)
- Ruchi Rastogi
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India 110029.
| | | | | | | | | |
Collapse
|
41
|
Abstract
Sarcomas comprise a heterogeneous group of mesenchymal neoplasms. They can be grouped into 2 general categories, soft tissue sarcoma and primary bone sarcoma, which have different staging and treatment approaches. This review includes a discussion of both soft tissue sarcomas (malignant fibrous histiocytoma, liposarcoma, leiomyosarcoma, synovial sarcoma, dermatofibrosarcoma protuberans, angiosarcoma, Kaposi sarcoma, gastrointestinal stromal tumor, aggressive fibromatosis or desmoid tumor, rhabdomyosarcoma, and primary alveolar soft-part sarcoma) and primary bone sarcomas (osteosarcoma, Ewing sarcoma, giant cell tumor, and chondrosarcoma). The 3 most important prognostic variables are grade, size, and location of the primary tumor. The approach to a patient with a sarcoma begins with a biopsy that obtains adequate tissue for diagnosis without interfering with subsequent optimal definitive surgery. Subsequent treatment depends on the specific type of sarcoma. Because sarcomas are relatively uncommon yet comprise a wide variety of different entities, evaluation by oncology teams who have expertise in the field is recommended. Treatment and follow-up guidelines have been published by the National Comprehensive Cancer Network (www.nccn.org).
Collapse
Affiliation(s)
- Keith M Skubitz
- Department of Medicine, University of Minnesota Medical School and Masonic Cancer Center, Minneapolis, USA.
| | | |
Collapse
|