Possible Complications

Prognosis

The overall 5-year survival rate for osteosarcoma is 68%, without significant gender difference. The age of the patient is correlated with the survival, with the poorest survival among older patients. Complete surgical excision is important to ensure an optimum outcome. Tumor staging, presence of metastases, local recurrence, chemotherapy regimen, anatomic location, size of the tumor, and percentage of tumor cells destroyed after neoadjuvant chemotherapy have effects on the outcome.

If the tumor has not spread to the lungs (pulmonary metastasis), long-term survival rates are very high. If the cancer has spread to other parts of the body, there is still a good chance of cure with effective treatment. Prognosis is separated into three groups:

1. Stage I - osteosarcoma is rare and includes parosteal osteosarcoma or low-grade central osteosarcoma. It has an excellent prognosis (>90%) with wide resection.

2. Stage II - if metastases are both local and regional, the prognosis is worse. It is better to have fewer metastases than longer time to metastases. Those with a longer length of time (>24months) and few nodules (2 or fewer) have the best prognosis with a 2-year survival after the metastases of 50% 5-year of 40% and 10-year - 20%.

3. Initial presentation of stage III osteosarcoma with lung metastates depends on the resectability of the primary tumor and lung nodules, degree of necrosis of the primary tumor, and maybe the number of metastases. Overall prognosis is about 30%.

o Limb removal

o Spread of cancer to the lungs

o Side effects of chemotherapy

 

Ewing’s family of tumors

The Ewing’s family of tumors (EFT) or a tumor of the Ewing’s family (TEF) is a group of cancers that start in the bones or nearby soft tissues that share some common features. They can develop at any age, but these tumors are most common in early teenage years.

 

There are 3 main types of Ewing tumors:

v Ewing sarcoma of bone: Ewing sarcoma that starts in the bone is the most common tumor in this family. This type of tumor was first described by Dr. James Ewing in 1921, who found it was different from the more common bone tumor, osteosarcoma. Its cells looked different from osteosarcoma cells when seen under a microscope. It was also more likely to respond to radiation therapy.

v Extraosseous Ewing tumor (EOE): Extraosseous Ewing tumors start in soft tissues around bones, but they look and act very much like Ewing sarcomas in bones. They are also known as extraskeletal Ewing sarcomas.

v Peripheral primitive neuroectodermal tumor (PPNET): This rare childhood cancer also starts in the bone or soft tissue and shares many features with Ewing sarcoma of bone and EOE. Peripheral PNETs that start in the chest wall are known as Askin tumors. (Peripheral PNETs are similar to, but not quite the same as, PNETs of the brain and spinal cord).

 

Researchers have found that the cells that make up Ewing sarcoma, EOE, and PPNET are very similar. They tend to have the same DNA (gene) abnormalities and share similar proteins, which are rarely found in other types of cancers. That’s why these 3 cancers are thought to develop from the same type of cells in the body. There are slight differences among these tumors, but they all get the same treatment.

Of the tumors in this family, Ewing’s tumor of bone represent around 87%, while EOE (at 8%) and PNET (at 5%) are much rarer.