Primary osteosarcoma in elderly patients: A report of three cases

Xu,Qiang; Gao,Tian; Zhang,Bin; Zeng,Jin; Dai,Min

doi:10.3892/ol.2019.10446

Primary osteosarcoma in elderly patients: A report of three cases

Authors:
- Qiang Xu
- Tian Gao
- Bin Zhang
- Jin Zeng
- Min Dai
View Affiliations

Affiliations: Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi 330006, P.R. China
Published online on: June 7, 2019 https://doi.org/10.3892/ol.2019.10446
Pages: 990-996
Copyright: © Xu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Osteosarcoma is the most common type of primary malignant bone tumor in children and young adults. However, primary osteosarcoma in elderly patients is rare. The present study reports 3 cases of advanced osteosarcoma in elderly patients. The pathological findings in all 3 cases confirmed the diagnosis of primary osteosarcoma. Notably, each patient received different treatment options. Chemoradiotherapy was recommended in case 1 due to the age of the patient. However, the patient requested to be discharged and was lost to follow‑up. Conversely, in case 2, the 62‑year‑old female patient underwent systemic chemotherapy, but no surgical treatment, and in case 3, the 51‑year‑old male patient underwent complete tumor resection and received systemic chemotherapy for late tumor recurrence. Early diagnosis of osteosarcoma in elderly patients is difficult, and misdiagnosis or a missed diagnosis is common. In clinical practice, bone tumors in elderly patients should be investigated carefully. Imaging examinations are essential for diagnosis, and biopsy is required for confirmation. However, the efficacy of chemotherapy for elderly patients with primary osteosarcoma remains uncertain. Collectively, due to the small number of reports of osteosarcoma in the elderly population, the 3 cases in the present study raise awareness of this rare condition.

View Figures

View References

1	Kansara M, Teng MW, Smyth MJ and Thomas DM: Translational biology of osteosarcoma. Nat Rev Cancer. 14:722–735. 2014. View Article : Google Scholar : PubMed/NCBI
2	Poletajew S, Fus L and Wasiutynski A: Current concepts on pathogenesis and biology of metastatic osteosarcoma tumors. Ortop Traumatol Rehabil. 13:537–545. 2011.(In English, Polish). View Article : Google Scholar : PubMed/NCBI
3	Centrella M, Horowitz MC, Wozney JM and McCarthy TL: Transforming growth factor-beta gene family members and bone. Endocr Rev. 15:27–39. 1994. View Article : Google Scholar : PubMed/NCBI
4	Bismar H, Klopinger T, Schuster EM, Balbach S, Diel I, Ziegler R and Pfeilschifter J: Transforming growth factor beta (TGF-beta) levels in the conditioncd mcdia of human bone cclls relationship to donor age bone volvme and cconcentration of TGF-beta in human bone matrix in vivo. Bone. 24:565–569. 1999. View Article : Google Scholar : PubMed/NCBI
5	Savage SA and Mirabello L: Using epidemiology and genomics to understand osteosarcoma etiology. Sarcoma. 2011:5481512011. View Article : Google Scholar : PubMed/NCBI
6	Meyers PA and Gorlick R: Osteosarcoma. Pediatr Clin North Am. 44:973–989. 1997. View Article : Google Scholar : PubMed/NCBI
7	Damron TA, Ward WG and Stewart A: Osteosarcoma, chondrosarcoma, and Ewing's sarcoma: National cancer data base report. Clin Orthop Relat Res. 459:40–47. 2007. View Article : Google Scholar : PubMed/NCBI
8	Anil S, Krishnan AP and Rajendran R: Osteosarcoma of the mandible masquerading as a dental abscess: Report of a case. Case Rep Dent. 2012:6350622012.PubMed/NCBI
9	Tsuchiya H, Kanazawa Y, Abdel-Wanis ME, Asada N, Abe S, Isu K, Sugita T and Tomita K: Effect of timing of pulmonary metastases identification on prognosis of patients with osteosarcoma: The japanese musculoskeletal oncology group study. J Clin Oncol. 20:3470–3477. 2002. View Article : Google Scholar : PubMed/NCBI
10	Williams RF, Fernandez-Pineda I and Gosain A: Pediatric sarcomas. Surg Clin North Am. 96:1107–1125. 2016. View Article : Google Scholar : PubMed/NCBI
11	Haduong JH, Martin AA, Skapek SX and Mascarenhas L: Sarcomas. Pediatr Clin North Am. 62:179–200. 2015. View Article : Google Scholar : PubMed/NCBI
12	Duffaud F, Digue L, Baciuchka-Palmaro M, Volot F, Perles-Daniel C, Garbe L and Favre R: Osteosarcomas of flat bones in adolescents and adults. Cancer. 88:324–332. 2000. View Article : Google Scholar : PubMed/NCBI
13	Ek ET, Ojaimi J, Kitagawa Y and Choong PF: Outcome of patients with osteosarcoma over 40 years of age: Is angiogenesis a marker of survival? Int Semin Surg Oncol. 3:72006. View Article : Google Scholar : PubMed/NCBI
14	Durnali A, Alkis N, Cangur S, Yukruk FA, Inal A, Tokluoglu S, Seker MM, Bal O, Akman T, Inanc M, et al: Prognostic factors for teenage and adult patients with high-grade osteosarcoma: An analysis of 240 patients. Med Oncol. 30:6242013. View Article : Google Scholar : PubMed/NCBI
15	Sadoghi P, Leithner A, Clar H, Glehr M, Wibmer C, Bodo K, Quehenberger F and Windhager R: The threat of misdiagnosis of primary osteosarcoma over the age of 60: A series of seven cases and review of the literature. Arch Orthop Trauma Surg. 130:1251–1256. 2010. View Article : Google Scholar : PubMed/NCBI
16	Wick MR, Siegal GP, Unni KK, McLeod RA and Greditzer HG III: Sarcomas of bone complicating osteitis deformans (Paget's disease): Fifty years' experience. Am J Surg Pathol. 5:47–59. 1981. View Article : Google Scholar : PubMed/NCBI
17	Frassica FJ, Frassica DA, Wold LE, Beabout JW and Sim FH: Postradiation sarcoma of bone. Orthopedics. 16:105–109. 1993.PubMed/NCBI
18	Ogura K, Higashi T and Kawai A: Statistics of bone sarcoma in Japan: Report from the bone and soft tissue tumor registry in Japan. J Orthop Sci. 22:133–143. 2017. View Article : Google Scholar : PubMed/NCBI
19	Ishikawa Y, Tsukuma H and Miller RW: Low rates of Paget's disease of bone and osteosarcoma in elderly Japanese. Lancet. 347:15591996. View Article : Google Scholar : PubMed/NCBI
20	Jeon DG, Lee SY, Cho WH, Song WS and Park JH: Primary osteosarcoma in patients older than 40 years of age. J Korean Med Sci. 21:715–718. 2006. View Article : Google Scholar : PubMed/NCBI
21	Nie Z, Lu Q and Peng H: Prognostic factors for patients with chondrosarcoma: A survival analysis based on the Surveillance, Epidemiology, and End Results (SEER) database (1973–2012). J Bone Oncol. 13:55–61. 2018. View Article : Google Scholar : PubMed/NCBI
22	Sergi C and Zwerschke W: Osteogenic sarcoma (osteosarcoma) in the elderly: Tumor delineation and predisposing conditions. Exp Gerontol. 43:1039–1043. 2008. View Article : Google Scholar : PubMed/NCBI
23	Lex JR, Evans S, Stevenson JD, Parry M, Jeys LM and Grimer RJ: Dedifferentiated chondrosarcoma of the pelvis: Clinical outcomes and current treatment. Clin Sarcoma Res. 8:232018. View Article : Google Scholar : PubMed/NCBI
24	Gumay S: Pathological diagnosis of bone sarcoma. Gan To Kagaku Ryoho. 27 (Suppl 2):S420–S426. 2000.
25	Bielack SS, Kempf-Bielack B, Heise U, Schwenzer D and Winkler K: Combined modality treatment for osteosarcoma occurring as a second malignant disease. Cooperative German-Austrian-Swiss Osteosarcoma Study Group. J Clin Oncol. 17:11641999. View Article : Google Scholar : PubMed/NCBI
26	Grimer RJ, Cannon SR, Taminiau AM, Bielack S, Kempf-Bielack B, Windhager R, Dominkus M, Saeter G, Bauer H, Meller I, et al: Osteosarcoma over the age of forty. Eur J Cancer. 39:157–163. 2003. View Article : Google Scholar : PubMed/NCBI
27	deSantos LA, Rosengren JE, Wooten WB and Murray JA: Osteogenic sarcoma after the age of 50: A radiographic evaluation. AJR Am J Roentgenol. 131:481–484. 1978. View Article : Google Scholar : PubMed/NCBI
28	Ferrari S and Palmerini E: Adjuvant and neoadjuvant combination chemotherapy for osteogenic sarcoma. Curr Opin Oncol. 19:341–346. 2007. View Article : Google Scholar : PubMed/NCBI
29	Wittig JC, Bickels J, Priebat D, Jelinek J, Kellar-Graney K, Shmookler B and Malawer MM: Osteosarcoma: A multidisciplinary approach to diagnosis and treatment. Am Fam Physician. 65:1123–1132. 2002.PubMed/NCBI
30	Agarwal M, Anchan C, Shah M, Puri A and Pai S: Limb salvage surgery for osteosarcoma: Effective low-cost treatment. Clin Orthop Relat Res. 459:82–91. 2007. View Article : Google Scholar : PubMed/NCBI
31	Kim HJ, Chalmers PN and Morris CD: Pediatric osteogenic sarcoma. Curr Opin Pediatr. 22:612010. View Article : Google Scholar : PubMed/NCBI
32	Rosen G, Caparros B, Huvos AG, Kosloff C, Nirenberg A, Cacavio A, Marcove RC, Lane JM, Mehta B and Urban C: Preoperative chemotherapy for osteogenic sarcoma: Selection of postoperative adjuvant chemotherapy based on the response of the primary tumor to preoperative chemotherapy. Cancer. 49:1221–1230. 1982. View Article : Google Scholar : PubMed/NCBI
33	Bacci G, Ferrari S, Donati D, Longhi A, Bertoni F, Di Fiore M, Comandone A, Cesari M and Campanacci M: Neoadjuvant chemotherapy for osteosarcoma of the extremity in patients in the fourth and fifth decade of life. Oncol Rep. 5:1259–1263. 1998.PubMed/NCBI
34	Manoso MW, Healey JH, Boland PJ, Athanasian EA, Maki RG, Huvos AG and Morris CD: De novo osteogenic sarcoma in patients older than forty: Benefit of multimodality therapy. Clin Orthop Relat Res. 438:110–115. 2005. View Article : Google Scholar : PubMed/NCBI
35	Huvos AG: Osteogenic sarcoma of bones and soft tissues in older persons. A clinicopathologic analysis of 117 patients older than 60 years. Cancer. 57:1442–1449. 1986. View Article : Google Scholar : PubMed/NCBI