Adapting therapeutic strategies for the treatment of osteosarcoma in pediatrics: Collaborative experience of the Central American Association of Pediatric Hemato-Oncology (AHOPCA)

Abstract

Osteosarcoma is the most frequent bone malignancy in children. There is a considerable gap in survival rates for pediatric sarcomas in Low Income Countries (LIC), related to non-biological factors of cancer tumor biology. In 1998, the Pediatric Hematology Oncology Centro America Association (AHOPCA) was created with the participation of four countries and the support ofexperts from Europe and North America, aiming to standardize treatment for pediatric cancer patient in the region to improve pediatric survival rates. From January 1999 December 2016, we conducted an observational, descriptive, retro-prospective and analytical study, the first AHOPCA-Osteosarcoma Collaborative Protocol. The variables included in the study were age, sex, disease extension, and type of surgery. Overall survival and event-free survival rates were obtained, using Kapplan-Meier curves and log Rank test. 485 new pediatric osteosarcoma cases were diagnosed in the participating centers. Only 392 cases met eligibility criteria. We observed high rate of metastatic disease (30%), and high rates of abandonment and refusal of local treatment (amputation). In the second era of the protocol, a new surgical strategy was introduced, with up-front amputation. This strategy did not significantly improve survival rates (p=0.69). In both treatment eras, overall survival rate was below 40%. The study demonstrated an important survival gap of osteosarcama compared to reported survival rates in developed countries. New research initiatives must be conducted to evaluate and address the role of social determinants, which affect negatively the survival rates of Pediatric Osteosarcoma in Central America.

Key words: Osteosarcoma, low-income countries, survival and socio-cultural factors