Research Article

High-Grade Osteosarcoma of the Foot: Presentation, Treatment, Prognostic Factors, and Outcome of 23 Cooperative Osteosarcoma Study Group COSS Patients

Table 1

Patient and tumor characteristics, treatment, and outcome.

Pat. no.AgeSexTumor siteTumor size (ml)Primary mets.APLDHPre-op chemotherapySurgical remissionType of surgeryTumor responsePostoperative chemotherapyEventFurther therapyEFS (years)OAS (years)Status

110FTarsus (calcaneus)40.56 max.; dimension: 6.5 cmNoneNNA, M, I, PCRAmputation lower leg below kneePoorA, M, I, ESMD (Ewing sarcoma)8.98.9DOC-SMD
212FTarsus (os cuneiforme lateral)5.5 max.; dimension 2.5 cmNoneNNA, M, I, PCRAmputation forefoot in Chopart jointGoodA, I, PNone1313LFU-CR1
312MTarsus (talus: position in the extensor aspect)12.08 max.; dimension 3 cmNoneA, M, I, PCRResection of talus, half os naviculare, and distal part of lateral calcaneus incl. sinus tarsi; reimplantation of proximal talus: tumor in 1 cm distancePoorA, M, I, PNone1111LFU-CR1
413MTarsus (talus medial part)31.2 max.; dimension 5 cm2–5 lungEEA, M, I, PNoEn bloc resection distal part of tibia, fibula and talusPoorA, P, E, HD-INo CR progressive lung mets., local rec.n.f.s.00.7DOD-primary disease
513MTarsus (calcaneus)36.11 max.; dimension 6.5 cmNoneENA, M, I, PCRAmputation of foot: exarticulation upper ankle jointPoorA, M, I, PNone7.67.6LFU-CR1
613MTarsus (calcaneus)54 max.; dimension 8 cmNoneENA, M, PCRAmputation lower leg below kneePoorA, M, PNone0.860.86CR1
723MTarsus (calcaneus)NoneNNA, M, PCRAmputation lower leg below kneePoorA, M, PNone0.90.9LFU-CR1
825FTarsus (calcaneus)NoneNNCOSS 96, n.f.sCRAmputation lower leg below kneen.f.s.None4.84.8LFU-CR1
925FTarsus (calcaneus)NoneNNA, M, I, PCRFirst operation: excochleation of cyst; second operation: amputation of lower leg below kneePoorA, M, I, PLymph node metastases ipsilateral groinSecond- and third-line chemotherapy0.81.4DOD-Rec1
1029FTarsus (calcaneus)NoneENA, M, PNoAmputation lower leg n.f.sPoorA, M, I, P, ENo CR: pulmonary filiae during preoperative chemo, mets. HWK4 and BWK 3Corporectomy of HWK4 and BWK3, mets. Os pubis, fourth rib02.1DOD-primary disease
1132MTarsus (os naviculare + cuneiforme III)Lymph node; left groinNEA, M, I, PCRAmputation: foot through calcaneus; resection of groin metastasesPoorA, M, I, PRec. lower leg and lung mets.Resection of distal fibula2.24.2DOD-Rec2
1233FTarsus (os naviculare)NoneEEA, M, I, PCRAmputation of forefootGoodA, I, P, E, MLung mets.High-dose chemo rejected4.95.0LFU-Rec1
1338MTarsus (calcaneus)32 (5 × 5 × 2.5 cm)NoneNNA, M, I, PCRFirst operation: intralesional excochleation of a “cyst,” second operation: amputation lower leg below kneeN.A. (primary OP)A, M, I, PLung mets. 3x2 × metastasectomies2.24.1DOD-Rec3
1438FTarsus (calcaneus)51 max.; dimension 7 cmNoneNA, M, I, PCRAmputation lower leg below kneePoorA, M, I, PNone1.11.1LFU-CR1
1556MTarsus (talus)NoneNNA, P, ICRAmputation distal lower legGoodA, P, INone2.02.0LFU-CR1
1658MTarsus (calcaneus)NoneNNCRFirst operation: resection of calcaneal cyst: second operation: amputation lower leg below kneeN.A. (primary OP)A, P, INone0.40.4LFU-CR1
1711FMetatarsale IV: proximal right partNoneNNA, P, MCRResection ray IV, metatarsale III and V reconstruction of axis III with fibulaPoorA, P, M, E, INone4.04.0LFU-CR1
1839FMetatarsale IV: mediocranial3.31 max.; dimension 3.5 cmNoneCRPartial resection of ray III–V through cuboid and cuneiforme IIIN.A. (primary OP)A, I, P, MLung mets.Rec. I–III: 3 × wedge resection of affected pulmonary site5.318.45CR3
1944MMetatarsale II, os cuneiforme II and IIINoneNNA, I, PCRAmputation forefoot in Chopart jointPoorA, P, INone1.61.6CR1
2044MMetatarsale VLungNNA, P, ICRFirst operation: amputation atypical in Chopart joint; second operation: wedge resection left lower lobeGoodI, P, M, ALung mets. bilateralNo further therapy: patient will1.54.72DUC-Rec1
2145MMetatarsale INoneNNA, P, ICRAmputation ray I and II and os navicularePoorA, P, INone2.02.0LFU-CR1
2245FPhalanx I: proximal partNoneNone; patient disbelieved diagnosisCRAmputation ray I and II rightN.A. (primary OP)NoneRec. 1: lung mets., Rec. 2: lung + popliteal fossa, and Rec. 3: lymph node mets.: lung, mediastinal, and abdominal2x wedge resection, amputation right leg1.56.6DOD-Rec3
2357MPhalanx distalis I31 max.; dimension 5 cmNoneNNCRAmputation phalanx IN.A. (primary OP)A, P, INone1.61.6LFU-CR1

Pat. = patient; No. = number; status = status at the last available follow-up; F = female; M = male; N = normal; E = elevated; N = normal; A = doxorubicin; M = methotrexate; I = ifosfamide; HD = high dose; P = cisplatin; E = etoposide; CR = complete surgical remission (primary tumor and metastases); good/poor tumor response = </≥10% viable tumor following pre-op. chemotherapy; SMD = secondary malignant disease; n.f.s. = not further specified; mets. = metastases; OP = operation; N.A. = not applicable; DOC = death of other cause; LFU = lost to follow-up; DOD = death of disease; Rec. = recurrence.