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Long-term follow-up care of 5 years or more is needed for patients treated for osteosarcoma, according to a recent article published in the Journal of Clinical Oncology.

Osteosarcoma is a cancer that starts in the bone. It is a disease that mainly affects young adults or adolescents. The most common site of cancer origin is in the bones around the knee. At present, patients are grouped according to whether the cancer is localized (has not spread from its site of origin) or metastatic (spread to distant sites in the body). Osteosarcoma of the extremity refers to cancer that is limited to one limb and has not spread to the rest of the body. Historically, amputation of the affected limb was a common treatment strategy. However, more recently, aggressive treatment with chemotherapy has reduced the need for amputation in approximately 80% of patients whose cancer is limited to one extremity.

Previous clinical trials have demonstrated that optimal outcomes for patients with osteosarcoma limited to the extremity can be achieved through treatment involving pre-operative chemotherapy, surgery to remove the cancer, and post-operative chemotherapy. However, the majority of these trials did not evaluate patients for longer than 3 years and very little is known about the long-term outcomes of patients treated for this disease. Long-term surveillance is important in order to identify any late complications that may develop from treatment as well as to detect early recurrence.

Researchers from Italy recently analyzed long-term follow-up data from 164 patients with osteosarcoma limited to the extremity who had been treated at their facility. These patients had been observed for at least 10 years following treatment. All patients had received pre-operative chemotherapy consisting of high-dose methotrexate, cisplatin, and doxorubicin (ADM). Patients were considered to be either “good responders” or “poor responders” depending on how their cancer responded to pre-operative ADM. Following surgery, good responders received ADM and poor responders received ifosfamide and etoposide in addition to ADM.

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Results from this data revealed that 61% of patients remained cancer free. There was no difference in outcomes between good responders and poor responders. Utilizing this approach, over 80% of patients were able to avoid amputation. Late complications of chemotherapy included injury to the heart, including 2 deaths, male infertility and the development of second cancers. In addition, some local and systemic cancer recurrences were observed 5 or more years following treatment.

Since some of the side effects from chemotherapy developed 5 or more years following completion of treatment, careful long-term follow-up is recommended for osteosarcoma patients treated with chemotherapy. It is important to detect and treat these complications early in order to lessen the severity of these side effects. Patients who have been treated for osteosarcoma of the extremity may wish to speak with their physician to ensure they have a good long-term follow-up plan. (Journal of Clinical Oncology, Vol 18, No 24, pp 4016-4027, 2000).