Osteosarcoma of the Head and Neck
Osteosarcoma of the head and neck (H&N OS) occurs in an older population compared to osteosarcoma of the extremities.[19,33,34,35,36,37] In the pediatric age group, osteosarcomas of the head and neck are more likely to be low or intermediate grade than tumors of the extremities.[38,39] All reported series stress the need for complete surgical resection.[19,33,34,35,36,37,38,39][Level of evidence: 3iiiA] H&N OS has a higher risk for local recurrence and a lower risk for distant metastasis than osteosarcoma of the extremities.[33,36,37,40] The probability for cure with surgery alone is higher for H&N OS than for extremity OS. Primary sites in the mandible and maxilla are associated with a better prognosis than other primary sites in the head and neck.[35,36,40] When surgical margins are positive, there is a trend for improved survival with adjuvant radiation therapy.[19,36][Level of evidence: 3iiiA] There are no randomized trials to assess the benefit of chemotherapy in H&N OS, but several series suggest a benefit.[33,41] Chemotherapy should be considered for younger patients with high grade H&N OS.
Treatment Options Under Clinical Evaluation
The COG, in collaboration with several European groups, has opened a trial in which all patients receive preoperative therapy with doxorubicin, cisplatin, and high-dose methotrexate. Patients are then divided into the following two strata on the basis of histologic necrosis in the resected primary tumor:
- Favorable histologic response (<10% viable tumor): COG-AOST0331: In this trial, all patients receive postoperative therapy with the same drugs as those given preoperatively. Patients will be randomly assigned to receive additional therapy with pegylated interferon alpha-2b.
- Standard histologic response (10%-100% viable tumor): COG-AOST0331: In this trial, patients will be randomly assigned to receive postoperative chemotherapy with the same drugs as those given preoperatively plus or minus additional courses of ifosfamide/etoposide.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with localized osteosarcoma and localized childhood malignant fibrous histiocytoma of bone. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
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