الفهرس 
Outcome of relapsing osteosarcoma patients, national cancer institute, Cairo university experience
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Abstract
Background: Osteosarcoma is the most common malignant bone tumor
in children and adolescents. However, a large number of patients who
respond completely to upfront therapy develop relapse, with a muchdecreased chance of survival after relapse (approximately 20%). The
prognosis of refractory or recurrent Osteosarcoma remains dismal.
Purpose: This study attempts to identify the outcome and different
prognostic factors predicting survival after relapse in Osteosarcoma
patients treated at Pediatric Oncology Department, National Cancer
Institute, Cairo University.
Methods: A retrospective study included 100 relapsed Osteosarcoma
patients, all patients treated at National Cancer Institute, Cairo University
who developed disease recurrence during the period from 1st of January
2008 to the end of June 2019.
Results: The 5-year post-relapse event free survival (PREFS) and postrelapse survival (PRS) of 100 patients were 10.5% and 12.3%,
respectively. The independent factors that significantly affect the event
free-survival were salvage 2nd line chemotherapy and complete second
surgical excision. Patients who did not receive 2nd line chemotherapy had
worse event free-survival compared to those who received it (HR: 3.5
[95%CI:1.9-6.6), p < 0.001; and patients who did not have 2nd
curative
surgery had worse event free-survival compared to those who did it (HR:
3.8 [95%CI:2.1-7.1), p<0.001.Thirty-eight out of 100 patients (38%) had
tumor progression post salvage therapy, 44 patients (44%) were in
complete remission and 18 patients (18%) were non-evaluable, while 30
patients developed 2nd recurrence after getting into 2nd complete
remission.
Conclusions: Patients with relapsed Osteosarcoma showed very poor
outcome. Favorable outcomes were associated with patients who
underwent adequate local control plus salvage chemotherapy post first
relapse.