EURO-B.O.S.S. A European study on chemotherapy in bone-sarcoma patients aged over 40: Outcome in primary high-grade osteosarcoma

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INTRODUCTION: The EUROpean Bone Over 40 Sarcoma Study (EURO-B.O.S.S.) was the first prospective international study for patients 41-65 years old with high-grade bone sarcoma treated with an intensive chemotherapy regimen derived from protocols for younger patients with high-grade skeletal osteosarcoma.

METHODS: Chemotherapy based on doxorubicin, cisplatin, ifosfamide, and methotrexate was suggested, but patients treated with other regimens at the investigators' choice were also eligible for the study.

RESULTS: The present report focuses on the subgroup of 218 patients with primary high-grade osteosarcoma. With a median follow-up of 47 months, the 5-year probability of overall survival (OS) was 66% in patients with localized disease and 22% in case of synchronous metastases. The 5-year OS in patients with localized disease was 29% in pelvic tumors, and 70% and 73% for extremity or craniofacial locations, respectively. In primary chemotherapy, tumor necrosis ≥90% was reported in 21% of the patients. There were no toxic deaths; however, hematological toxicity was considerable with 32% of patients experiencing 1 or more episodes of neutropenic fever. The incidence of nephrotoxicity and neurotoxicity (mainly peripheral) was 28% and 24%, respectively. After methotrexate, 23% of patients experienced delayed excretion, in 4 cases with nephrotoxicity.

CONCLUSIONS: In patients over 40 years of age with primary high-grade osteosarcoma, an aggressive approach with chemotherapy and surgery can offer the probability of survival similar to that achieved in younger patients. Chemotherapy-related toxicity is significant and generally higher than that reported in younger cohorts of osteosarcoma patients treated with more intensive regimens.


  • Stefano Ferrari
  • Stefan S. Bielack
  • Sigbjørn Smeland
  • Alessandra Longhi
  • Gerlinde Egerer
  • Kirsten Sundby Hall
  • Davide Donati
  • Matthias Kevric
  • Otte Brosjö
  • Alessandro Comandone
  • Mathias Werner
  • Odd Monge
  • Emanuela Palmerini
  • Wolfgang E. Berdel
  • Bodil Bjerkehagen
  • Anna Paioli
  • Sylvie Lorenzen
  • Marco Gambarotti
  • Per Ulf Tunn
  • Nina L. Jebsen
  • Marilena Cesari
  • Thekla von Kalle
  • Virginia Ferraresi
  • Rudolf Schwarz
  • Rossella Bertulli
  • Anne Katrin Kasparek
  • Giovanni Grignani
  • Fatime Krasniqi
  • Benjamin Sorg
  • Stefanie Hecker-Nolting
  • Piero Picci
  • Peter Reichardt
Enheter & grupper
Externa organisationer
  • Oslo university hospital
  • University Hospital Heidelberg
  • Karolinska University Hospital
  • Haukeland University Hospital
  • Universitätsklinikum Münster
  • National Cancer Institute Regina Elena
  • University Medical Center Hamburg-Eppendorf
  • Istituto Nazionale dei Tumori
  • Medical University of Graz
  • University Hospital Basel
  • Rizzoli Orthopedic Institute
  • Klinikum Stuttgart Olgahospital
  • Ospedale Humanitas Gradenigo
  • HELIOS Klinikum Emil von Behring
  • Technical University of Munich
  • HELIOS Klinikum Berlin-Buch
  • Institute for Cancer Research and Treatment, Candiolo

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Cancer och onkologi


Sidor (från-till)30-36
Antal sidor7
StatusPublished - 2018 jan 1
Peer review utfördJa