Osteosarcoma outcomes in Johannesburg: a retrospective multicentre review
Date
2019
Authors
Nasar, Ali
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Abstract
There is limited literature on the topic of paediatric osteosarcoma in South Africa, in particular status at presentation to tertiary hospital and five-year survival rates. The objective of this study was to evaluate the clinical outcomes of children younger than 18 years of age with osteosarcoma at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Chris Hani Baragwanath Academic Hospital (CHBAH) and Wits Donald Gordon Medical Centre (WDGMC), tertiary hospitals in Johannesburg, South Africa, and compare these with similar studies in the developing world. This was a retrospective study of 102 children treated at CMJAH, CHBAH and WDGMC between 1985 and 2015. Records of children with osteosarcoma kept at the three hospitals were reviewed to assess them at the time of presentation and the five-year survival rates following treatment. An average of 113.7 days (74.2 SD) elapsed before patients presented to hospitals for medical care after the onset of symptoms. Conventional osteosarcoma constituted just over 92.2% of the cases. Most patients (n = 52, 51%) were at Enneking stage III, 39 (38.2%) were at stage IIB, 10 (9.8%) were at stage IIA, and none presented at stage 1A or stage IB. Of all the patients, 17 (16.7%) underwent limb salvage surgery (LSS), 33 (32.4%) had amputations, nine (8.9%) had disarticulation of either the hip or shoulder, 11 (10.8%) declined surgery and were referred for palliative treatment and 18 (17.7%) were not fit for surgery and received palliative care only. The treatment given in eleven patients (10.8%) was not recorded. The five-year overall survival rate was 42%. There were no significant differences (p > 0.05) in the mean survival time between males and females. After surgery, the five-year survival rate was higher (p < 0.05) in males (~42%) compared with females (~30%). The children that had limb salvage surgery (LSS) had a significantly higher (p < 0.05) five-year overall survival are (76% vs 44%) than those children that had their limbs amputated. More than 51% of patients in this cohort from three hospitals in Johannesburg presented for medical attention at tertiary hospitals after the disease had metastasized. The five-year survival rates from this cohort are better than those published in other developing countries but significantly lower than those in the developed world. This study highlights the need for ongoing education of the general public about the dangers of delayed medical attention. Urgency is required, to facilitate rapid tertiary referral, expedite management and potentially improve outcomes.
Description
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of
Master of Medicine, Johannesburg, 2019
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Citation
Nasar, Ali Mohammed Omar, Osteosarcoma outcomes in Johannesburg:a retrospective multicentre review, University of the Witwatersrand, Johannesburg, <http://hdl.handle.net/10539/29875>