Osteosarcoma in Patients Older Than 65 Years Alessandra Longhi, Costantino Errani, Daniel Gonzales-Arabio, Cristina Ferrari, and Mario Mercuri From the Department of Musculoskele- tal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy. Submitted October 19, 2007; accepted April 8, 2008; published online ahead of print at www.jco.org on September 22, 2008. Authors’ disclosures of potential con- flicts of interest and author contribu- tions are found at the end of this article. Corresponding author: Alessandra Longhi, MD, Sezione Chemioterapia, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; e-mail: alessandra.longhi@ior.it. © 2008 by American Society of Clinical Oncology 0732-183X/08/2633-5368/$20.00 DOI: 10.1200/JCO.2007.14.9104 A B S T R A C T Purpose We reviewed the outcome of osteosarcoma patients older than 65 years, an age group usually excluded from protocols, to determine the different clinical features and prognostic factors in this age group compared with younger patients. Patients and Methods Patients treated at our institute who had high-grade osteosarcoma and were older than 65 years were observed. Results Forty-three patients were eligible to be enrolled onto this study; of these, 22 were male and 21 were female. The median age of this group was 69 years (range, 65 to 80 years). Of the 43 patients, 29 patients had localized disease, and 14 patients had metastatic disease. Localizations were appendicular in 33 patients, and axial in 10 patients. Twenty-nine patients had a primary osteosarcoma, 13 patients (30%) had a sarcoma in Paget’s disease, and one patient had postradiotherapy (RT) osteosarcoma. The median interval from onset of symptoms to diagnosis was 4 months (range, 0 to 73 months).Thirty-two of 43 patients received surgery for a primary tumor. Of these, 18 patients had limb salvage, 13 patients had an amputation, and one patient had palliative surgery; the remaining 11 patients received palliative RT. Fourteen patients received chemotherapy; two deaths related to chemotherapy were observed. Median overall survival (OS) for all 43 patients was 19 months (range, 3 to 229 months); 5-year OS was 22% (SE = 3%) for the whole group, and 45% OS for those patients with localized primary osteosarcoma. Multivariate analysis demonstrated that stage, volume, and surgery were significant prognostic factors. Insignificant prognostic factors were sex, type of surgery, chemotherapy, and Paget’s disease. Conclusion Patients older than 65 years with osteosarcoma have a worse prognosis compared with younger patients. This older age group is characterized by a longer time lapse from the onset of symptoms to diagnosis, more metastatic cases at diagnosis, less use of limb salvage, fewer patients receiving chemotherapy, and more patients excluded from clinical trials than a younger age group. J Clin Oncol 26:5368-5373. © 2008 by American Society of Clinical Oncology INTRODUCTION Due to prolonged life expectancy, interest is growing in geriatric oncology. It has been estimated that by 2050, 80% of cancers will occur in patients older than age 60 years. 1 In Italy, 20% of the population is currently older than age 60 years. 2 In the last decade, few studies have been published about breast, lung, colon, and ovary cancer in the elderly population. A need for an alternative evaluation system of an older individual’s functional status, together with the need to identify markers of frailty, has emerged to identify the elderly who can benefit from aggressive cancer treatment. 3 Osteosarcoma is a malignant bone tumor. Most cases occur between 10 and 20 years of age, peaking during the adolescent growth spurt and in the seventh and eighth decades of life. Before the 1970s, the prognosis for patients with high- grade osteosarcoma was poor, with long-term survival rates of less than 20%. 4 Advances in ad- juvant and neoadjuvant chemotherapy have im- proved the 5-year disease-free survival to more than 60%, 4 and improved surgical techniques have changed the proportion of amputation ver- sus limb salvage; the current rate of limb salvage is 71% to 90%. 5,6 However,these data are not appli- cable to adult patients older than age 40 years because all trials are tailored for a younger popu- lation. Few studies have evaluated the treatment and outcome of patients older than age 40 years. In a previous study, we compared the survival of 29 patients, age 40 to 60 years, with localized osteosarcoma of the extremities who were treated JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T VOLUME 26  NUMBER 33  NOVEMBER 20 2008 5368 © 2008 by American Society of Clinical Oncology Downloaded from jco.ascopubs.org on November 1, 2012. For personal use only. No other uses without permission. Copyright © 2008 American Society of Clinical Oncology. All rights reserved.