Objective: In this study, we sought to review the clinical and histopathological features and thechemotherapy regimens in osteogenic sarcoma in patients over 40 years of age, and we aimed atidentifying the possible prognostic factors in this particular group of patients.Methods: We reviewed 287 patients with osteosarcoma treated between the year 1986 and 2010. Patients from this group who met the following criteria were considered eligible for our study; presence ofprimary OS, had typical histological and radiographic features of OS, no prior history of cancer or anytreatment elsewhere and no prior history of preexisting bone abnormalities.Results: The KaplaneMeier survival curve for the entire group, with a 95% conŞdence interval, at two andŞve years showed the survival rates as 76.2% and 72.8% respectively. The surgical margin was a signiŞcantfactor affecting the survival. Presence of a pathological fracture also had a signiŞcant effect on the survival rate.Conclusion: Osteogenic sarcoma remains a challenging disease to treat. Despite the expectation thatelderly patients may not tolerate aggressive modern chemotherapy as the younger patients, we believethat patients with primary OS over the age of 40 should be treated aggressively with effective chemotherapy and complete surgical excision whenever possible.Level of evidence: Level IV, therapeutic study© 2017 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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Stark A, Kreicbergs A, Nilsonne U, Silversward C. The age of osteosarcoma patients is increasing: an epidemiological study of osteosarcoma in Sweden. 1971 to 1984. J Bone Jt Surg. 1990;72-B:89e93.
Corsi B, Rock MG. Primary osteosarcoma in adults older than 40 years. Clin Orthop Relat Res. 2002;397:53e61.
Unni KK. General aspects and data on 11,087 cases. In: Dahlin's Bone Tumors. 5th ed. Philadelphia: Lippincott-Raven; 1996:143e196.
Campanacci M. In: Enneking FW, ed. Bone and soft tissue tumors. 2nd ed. Padova: Piccin Nuova Libraria; 1999:463e558.
Manos MW, Healey JH, Boland PJ, et al. De Novo osteogenic sarcoma in patients older than forty: beneŞts of multimodality therapy. Clin Orthop Relat Res. 2005;438:110e115.
Delephine N, Delephine G, Bacci G, Rosen G, Desbois J. Influence of Metho- trexate dose intensity on outcome of patients with high grade osteogenic sarcoma: analysis of literature. Cancer. 1996;78:2127e2135.
Glasser D, Lane J, Huvos A, Marcove R, Rosen G. Survival, prognosis, and therapeutic response in osteogenic sarcoma. Cancer. 1992;69:698e708.
Kager L, Zoubek A, PEURotschger U. Primary metastatic osteosarcoma: presentation and outcome of patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol. 2003;21:2011e2018.
Winkler K, Beron G, Delling G, et al. Neoadjuvant chemotherapy of osteosar- coma: results of a randomized cooperative trial (COSS-82) with salvage chemotherapy based on histological tumour response. J Clin Oncol. 1998;6: 329e337.
Bacci G, Ferrari S, Donati D, et al. Neoadjuvant chemotherapy for osteosarcoma of the extremity in patients in the fourth andŞfth decade of life. Oncol Rep. 1998;5:1259e1263.
Grimer RJ, Cannon SR, Taminiau AM, et al. Osteosarcoma over the age of forty. Eur J Cancer. 2003;39:157e163.
Huvos AG. Osteogenic sarcoma of bones and soft tissues in older persons: a clinicopathological analysis of 117 patients older than 60 years. Cancer. 1986;57:1442e1449.
Duffaud F, Digue L, Baciuchka-Palmaro M, et al. Osteosarcomas offlat bones in adolescents and adults. Cancer. 2000;88:324e332.
Heare TC, Enneking WF, Heare MM. Staging techniques and biopsy of bone tumours. Orthop Clin North Am. 1989;20:273e285.
Kaplan FL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;52:457e481.
Okada K, Hasegawa T, Nishida J, et al. Osteosarcomas after the age of 50: a clinicopathologic study of 64 cases- an experience in Northern Japan. Ann Surg Oncol. 2004;11:998e1004.
Mankin HJ, Hornicek FJ, Rosenberg AE, Harmon DC, Gebhardt MC. Survival data for 648 patients with osteosarcoma treated at one institution. Clin Orthop Relat Res. 2004;429:286e291.
Unni KK. Osteosarcoma of bone. J Orthop Sci. 1998;3:287e294.
Saeter G, Hoie J, Stenwig AE, Johansson AK, Hannisdal E, Solheim OP. Systemic relapse of the patients with osteogenic sarcoma. Prognostic factors for long term survival. Cancer. 1995;75:1084e1093.
Naka T, Fukada T, Shinohara N, Iwamoto Y, Sugioka Y, Tsuneyashi M. Osteo- sarcoma versus malignantŞbrosus histiocytoma of bone in patients older than 40 years. Cancer. 1995;76:972e984.
Cheng CL, Ma J, Wu PC, Mason RS, Posen S. Osteomalacia secondary to osteo- sarcoma. A case report. J Bone Jt Surg Am. 1989;71:288e292.
Dorfman HD, Czerniak B. Bone cancers. Cancer. 1996;45:203e210.
Saeter G, Bruland OS, Folleras G, Boysen M, Hoie J. Extremity and non- extremity high-grade osteosarcoma: the Norwegian Radium Hospital experi- ence during the modern chemotherapy era. Acta Oncol. 1996;35:129e134.
Saeter G, Wiebe T, Wiklund T, et al. Chemotherapy in osteosarcoma. The Scandanavian Sarcoma Group experience. Acta Orthop Scand. 1999;70:74e82.
Bielack SS, Flege S, Kempf-Bielack B, et al. Osteosarcoma in adults. An analysis of 340 patients presenting in the third decade of life or later. Ann Oncol. 2000;11:125e132.