Outcome of radiation-related osteosarcoma after treatment of childhood andadolescent cancer: A study of 23 cases

Purpose: We analysed the clinical features and outcome of patients with rad iatian-associated osteosarcoma treated during the era of contemporary chemo therapy. Patients and Methods: The characteristics and outcome of 23 patients (17 ma les and six females) treated during childhood or adolescence for a solid tu mor who later developed osteosarcomas within the radiation field between 19 81 and 1996 were reviewed. Results: The median dose of radiation delivered to the first cancer war 47 Gy. Nineteen patients also received chemotherapy, The median time between r adiotherapy and the diagnosis of secondary osteosarcoma was 8 years. Histol ogic slide review showed conventional central osteosarcoma with various dif ferentiation patterns in 21 cases, together with one case of high-grade sur face osteosarcoma and one of periosteal osteosarcoma. The sites of involvem ent were the craniofacial bones in six cases, the first cervical vertebra i n one, the girdle bones in seven, and the extremities of long bones in nine . Three patients had metastatic disease at the diagnosis of osteosarcoma. P alliative therapy was administered to seven patients. The aim of treatment was curative for 16 patients,two of whom underwent amputation without furth er therapy. Intensive chemotherapy regimens were administered to 14 patient s before and/or after surgery. Fifteen patients achieved complete surgical remission. Twelve patients were alive and disease-free at a median follow-u p duration of 7.5 years. Overall and event-free survivals at 8 years were 5 0% and 41%, respectively. Conclusion: Patients with radiation-related osteosarcoma and resectable les ions can be cured with surgery and intensive preoperative and postoperative chemotherapy.