Osteosarcoma in children and adolescents: Experience from a tertiary hospital in South Africa

Abstract

Background: Osteosarcoma (OS) is the most common malignant primary bone tumour in childhood and adolescence. There is a paucity of data regarding the characteristics, management and outcomes in low- and middle-income countries, including South Africa.
Aim: This article describes the clinical characteristics, management options and outcomes of OS in children and adolescents.
Setting: The study was conducted at Universitas Academic Hospital, serving the Free State, neighbouring provinces, and Lesotho.
Methods: A retrospective, descriptive study was conducted on patients under 15 years treated for OS between January 2000 and December 2021. Data included demographics, clinical features, investigations (blood tests, imaging, histology), treatments (biopsy, surgery, chemotherapy), and outcomes (survival, mortality, morbidity). Data sources were the Paediatric Oncology Unit’s database, patient files, and electronic medical records.
Results: Forty-nine patients were included (median age: 11 years; IQR: 8–20), with 49% (n = 24/49) male. Enneking stage 3 was seen in 51% (n = 25/49), of whom 48% (n = 12/25) had pulmonary metastases. Amputation was performed in 69% (n = 34/49), and limb-salvage in 4% (n = 2/49). Two- and five-year survival rates were 45% and 28%, respectively. Among non-survivors (n = 33), contributing factors included advanced disease (58%, n = 19/33), refusal of treatment (18%, n = 6/33), chemotherapy-related toxicity (12%, n = 4/33), and sepsis (6%, n = 2/33).
Conclusion: Outcomes reflect high rates of locally advanced or metastatic disease. Delayed presentation and treatment refusal remain major barriers to survival. Collaborative data collection is essential to refine management protocols and improve outcomes in this population.
Contribution: Provides essential South African data to inform osteosarcoma care and improve outcomes.