Original Research

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

Annette Venkatesan, Jan du Plessis

Received: 21 Feb. 2025; Accepted: 26 June 2025; Published: 15 Sept. 2025

Copyright: © 2025. The Author(s). Licensee: AOSIS.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: osteosarcoma; paediatrics; adolescents; outcomes; management; tertiary hospital; survival; mortality; South Africa.

Introduction

Cancer remains one of the leading causes of mortality among children and adolescents.^1,2 Osteosarcoma (OS) is the most prevalent malignant primary bone tumour in this population.^3,4,5,6,7,8 It is an aggressive malignancy, often presenting with micro-metastases, predominantly to the lungs.^{9,10,11,12,13}

Prior to the 1970s, amputation was the primary treatment modality, associated with a 5-year survival rate below 20%.^5,10,14 Fortunately, in developed countries, today, a cure rate of 60% to 80% can be expected in children presenting with non-metastatic, localised disease.^4,7,12,15,16 However, the presence of pulmonary metastases reduces the 5-year survival rate to between 10% and 20%, with even lower rates observed in cases with bony metastases.^12,15,16,17 Unfortunately, for many patients in developing countries, the overall survival rate remains significantly lower.^17,18

In a developing country such as South Africa, one study reported that adult patients had an overall survival rate of 63% at 1 year and 38% at 5 years.⁵ Another study reported a 5-year overall survival rate of 58%, a local recurrence rate of 76% and a disease-free survival rate of 48%.⁶ Ga-Rankuwa Hospital, a tertiary referral centre in South Africa, reported a 1-year survival rate of 26% and a 5-year rate of 8% in 66 patients treated over a 10-year period, citing late presentation as the main contributor to poor outcomes.¹⁹ Overall, these studies show that the 5-year survival rate in South Africa ranges from 7% to 60%.^4,5,6,19

Further data on OS outcomes in South African children and adolescents are limited. The studies by Hart et al., Lisenda et al., Ferreira et al. and Muthuphei et al. provide valuable insights, but do not focus exclusively on younger patients.^4,5,6,19 A study by Shipley included both adult and paediatric patients treated at a tertiary centre over a 5-year period, with most patients in their second decade of life.²⁰ This underscores the need for research specifically targeting childhood and adolescent outcomes to inform strategies aimed at improving survival rates in this group.

Several factors influence survival outcomes in OS, including sex, age at diagnosis, primary tumour site, aetiology (primary or secondary), presence of metastases, tumour size, elevated alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) levels, histological subtype, surgical approach and response to neoadjuvant chemotherapy.^3,4,6 While some factors are immutable, others – such as time to presentation, access to surgery and chemotherapy regimens – are modifiable and can be optimised to enhance patient outcomes. Comprehensive retrospective data encompassing these variables are essential for guiding future research and refining management protocols. Therefore, further research is essential to contribute to the limited childhood and adolescent data currently available in South Africa and other developing countries.

The standard treatment for OS involves neoadjuvant chemotherapy, followed by surgical resection and adjuvant chemotherapy.^6,10,12,15 However, the specific chemotherapeutic agents used can vary between institutions, complicating the development of standardised, evidence-based treatment protocols.⁵

This study aims to describe the clinical characteristics and outcomes of children and adolescents diagnosed with OS and treated at a tertiary hospital in South Africa between January 2000 and December 2021.

Methods

This is a retrospective descriptive quantitative study in which an audit of children and adolescents treated for OS was performed. The study was conducted at Universitas Academic Hospital, which is the tertiary teaching hospital of the University of the Free State, catering not only to the Free State province but to patients from neighbouring provinces and Lesotho. All children and adolescents (aged less than 15 years old) with biopsy-confirmed OS that were treated from 01 January 2000 to 31 December 2021 were included. Patients whose clinical files and/or records were not available were excluded.

Data were obtained from the patient information database of the Paediatric Oncology Unit (POU), patient files and electronic patient records. An electronic data collection form was designed on Google Forms and was exported to a Google Sheets spreadsheet for analysis. The electronic form included, but was not limited to, sections for demographic data, history and clinical findings, investigations (blood tests, radiography and histology), treatment (biopsy/surgical interventions and chemotherapy) and outcomes (death, survival and morbidity).

Data analysis

Data were analysed using the SAS statistical software package, version 9.4 (SAS Institute Inc., Cary, NC, US). Descriptive statistical methods were used to summarise the demographic, clinical and treatment characteristics of the study population. Continuous variables (e.g. age and tumour size) were summarised using means and standard deviations or medians and interquartile ranges, depending on data distribution. Tumour diameters were approximated using a mean diameter (average of length and width) from histology reports. Categorical variables (e.g. sex, tumour site, histological subtype and staging) were reported using frequencies and percentages. Survival was assessed descriptively as the proportion of patients alive or deceased at the end of the study period. Survival time was not calculated, and no time-to-event analysis was performed. No inferential statistical analyses were conducted, as the primary aim of the study was to provide a descriptive overview of clinical characteristics and outcomes.

Ethical considerations

Ethical clearance to conduct this study was obtained from the University of the Free State Health Sciences Research Ethics Committee (reference number: UFS-HSD2022/0690/2709).

Results

Patient characteristics

A total of 49 patients were included in the study (Table 1). The sex distribution was nearly equal, with 51% (25/49) being female patients and 49% (24/49) male patients. The majority of patients were aged 11–15 years 61% (30/49), followed by those aged 6–10 years 29% (14/49) and ≤ 5 years 10% (5/49). The majority of patients were Black people 86% (42/49), with smaller proportions identifying as Coloured people 10% (5/49) and 4% (2/49) as White people.

In terms of referral origin, 59% (29/49) of patients were referred from within the Free State province, 22% (11/49) from Lesotho, 14% (7/49) from the Northern Cape and 4% (2/49) from the Eastern Cape. Comorbid conditions were identified in 18% (9/49) of the cohort. These included tuberculosis 4% (2/49), cardiomyopathy 4% (2/49) and 2% (1/49) human immunodeficiency virus (HIV). Asthma, autoimmune disease (myasthenia gravis), hydatid disease (echinococcosis) and hodgkins lymphoma were all other additional conditions seen. The patient with HIV was virally unsuppressed and on first line antiretroviral therapy.

Clinical presentation at diagnosis was dominated by musculoskeletal symptoms. Limb pain was reported in 81% (40/49) and limb swelling in 79% (39/49) of patients. Additional presenting complaints included weight loss 32% (16/49), loss of appetite 20% (10/49), pathological fractures 12% (6/49), limping 4% (2/49) and fatigue 2% (1/49).

Nutritional status was assessed using age-appropriate growth charts and classified according to the World Health Organization (WHO) criteria. Among the 49 patients, 57% (28/49) had a normal nutritional status. Thinness, defined by the WHO body mass index criteria for patients aged 5 to 19 years, was identified in 16% (8/49), while moderate wasting, assessed in children under 5 years of age, was observed in 6% (3/49). Nutritional status was unspecified in one patient, 2% (1/49).

Disease characteristics

The most common site of OS was the femur in 57% (28/49) and the tibia in 20% (10/49) of patients. The clivus, fibula, humerus, pelvic ilium, mandible, radius and ribs were also affected. The main histological subtype was conventional OS in 67% (33/49) of patients, and of this total, 79% (26/33) were osteoblastic, 8% (4/49) were chondroblastic and 2% (1/49) were fibroblastic. Enneking stage 3 was the most common staging in 51% (25/49) of patients, followed by stage 2B 29% (14/49), stage 2a 16% (8/49) and stage 1A 4% (2/49). Of this total of Enneking stage 3 patients, 49% had pulmonary metastases. Tumour diameters of ≥ 8 cm were seen in 41% (20/49) of patients, diameters < 8cm in 33% (16/49) and 27% (13/49) were unknown (Table 2).

The diagnosis was confirmed by biopsy in 98% (48/49) of patients, but one patient had a resection before being referred to oncology. A total of 43% (21/49) of patients had raised ALP levels and of these patients 52% (11/21) were Enneking stage 3. Lactate dehydrogenase was raised in 33 patients, and of this, 64% (21/33) were Enneking stage 3. The majority of patients who died were Enneking stage 3 with mainly long bone involvement.

Computed tomography (CT) of the chest was available for 94% of patients (46/49), magnetic resonance imaging (MRI) of the affected region for 84% (41/49), SPECT/PET scans were performed in 78% (38/49), and chest or regional X-rays were available for 59% (29/49) of the patients (Table 3).

Management

Neo-adjuvant chemotherapy was given in 86% (42/49) of patients. The remaining 12% (6/49) of patients underwent primary amputation, with one patient transferred back to the referring centre for the procedure. Most patients (83% [35/49]) had the combination of doxorubicin and cisplatin as part of neo-adjuvant chemotherapy. Only 8% (4/49) of patients were given high-dose methotrexate, doxorubicin and cisplatin (MAP). This is likely attributable to the recent introduction of the methotrexate-containing protocol in 2019. The majority of patients (55% [23/42]) received three cycles of neoadjuvant chemotherapy. The patients classified as ‘other’ included two who received a regimen comprising doxorubicin, cisplatin, ifosfamide, etoposide, and carboplatin, and one in whom doxorubicin was substituted with epirubicin due to availability constraints (Table 4).

Adjuvant chemotherapy was given to 76% (37/49) of patients, with 57% and 22% receiving doxorubicin and cisplatin, and MAP, respectively. Most patients (49% [18/37]) received three cycles of adjuvant chemotherapy (Table 4).

Amputations accounted for 69% (34/49) of all surgical interventions, 6% (3/49) were upfront amputations before chemotherapy, and limb salvage was attempted in only two (4%) patients. No surgery was performed in 20% (10/49) of patients, and reasons included refusal of surgery (12% [6/49]), death before amputation (6% [3/49]) and inoperable tumours (2% [1/49]) (Figure 1).

FIGURE 1: Distribution of surgical interventions and survival outcomes in childhood and adolescent osteosarcoma patients.

The majority of patients 47% (23/49) had an unknown histological response; the remaining findings showed Grade 1 necrosis in 16% (8/49), Grade 2 in 16% (8/49), Grade 3 in 12% (6/49) and 4% (2/49) of patients with Grade 4 necrosis (Figure 2).

FIGURE 2: Histological response to neoadjuvant chemotherapy in childhood and adolescent osteosarcoma patients (N = 49).

Tumour necrosis was graded using the Huvos grading system: Grade 0 (no necrosis), Grade 1 (< 50% necrosis), Grade 2 (50% – 89%), Grade 3 (90% – 99%) and Grade 4 (100% necrosis), with Grade 3 and Grade 4 considered good responses. A substantial proportion of patients (47%) had no documented histological response, as this was not commented on in the histopathology reports.

Outcomes

A total of 49 patients were enrolled in this study, with follow-up commencing at the conclusion of treatment and extending until the occurrence of the defined outcome. However, documented treatment end dates were available for only 31 patients, which were used to determine a median follow-up duration of 2 years, with an interquartile range of 5.5 years.

Data analysis revealed that 67% (33/49) of patients had died, while 31% (15/49) remained alive. Among the surviving patients, 60% (9/15) had survived for less than 5 years following the completion of treatment, while 40% (6/15) had survived for more than 5 years. Of those who survived, 53% (8/15) achieved remission, and 20% (3/15) experienced a relapse.

The 2-year and 5-year survival rates were 45% (21/47) and 28% (13/47), respectively. Two patients were excluded from the survival analysis: one because of the absence of a documented treatment start date, and the other who passed away prior to the initiation of treatment.

The majority of patients died because of advanced disease in 58% (19/33). Toxicity from chemotherapeutic agents was seen in 12% (4/33) of patients, and sepsis in 6% (2/33). Refusal of treatment was seen in 18% (6/33) of the patients who died. The remainder of the deaths were unknown as they were lost to follow up 9% (3/33), and noted to have died at home, 7% (2/33) (Figure 3).

FIGURE 3: A summary of the outcome of patients. The colours represent events relating to each outcome.

Discussion

Patient characteristics

Literature has consistently shown a male predominance in OS and this has been associated with poorer outcomes.^{3,5,6,7,8,9,18} However, one study reported that the difference in survival between sexes was not statistically significant.¹⁸ In our study, male patients and female patients were almost equally affected, but more male patients survived following treatment. This study could not demonstrate a bimodal age distribution normally seen with OS^5,6,8,12 as only patients aged 15 years old or less were included. However, the mean age seen was 11 years old, which is in keeping with the expected first peak. Almost all patients treated in this study were Black people. Race, however, has not been shown to be the most defining prognostic factor in OS, but literature has shown worse outcomes in Black people as opposed to White people.^3,5,12,21 The significance of this is unknown because of a high probability of selection bias in these studies. This is seen with studies with a predominance of White people in the sample investigated in America, compared to the predominance of Spanish people in Chile.^22,23

Most patients were from the Free State province; however, almost a quarter of our patients were referred from outside. Delayed presentations, due to limited resources at neighbouring referring centres and delays in referral for specialised care, may have contributed to the poor outcomes observed in this study. Many patients are referred to different hospitals and departments before they finally arrive at the appropriate facility. Nevertheless, the POU has created professional relationships with doctors at these referral facilities to aid prompt referrals, investigations and management. This applies not only to patients with OS, but for any paediatric patient with a confirmed or suspected malignancy.

According to the WHO classification of nutritional status, only nine patients were severely thin, and the majority were at Enneking stage 3. Almost half of the patients had localised disease, which could account for their normal nutritional status.

Secondary OS has a poor prognosis.³ The majority of our patients had primary lesions. Only one patient had secondary osteosarcoma, following prior chemotherapy for Hodgkin’s lymphoma. The patient developed pulmonary and bone metastases, experienced recurrence two years after amputation, was treated with chemotherapy for osteosarcoma, but unfortunately died from advanced disease.

The majority of patients presented with limb pain and swelling. Characteristically, the pain was constant and worsened over time.^3,9 Constitutional symptoms such as loss of appetite and subsequently loss of weight were not as common, which could account for most normal nutritional statuses seen. Fractures were uncommon in our study but were in keeping with the 5% – 12% reported.^4,5,24 In patients with Enneking stage 2B and 3, limb pain was the main complaint, although patients had delayed presentations despite this symptom. A study postulated that patients adapt to their limitations and therefore may have delayed presentations.²⁵ For many in South Africa and developing countries who do not have easy access to health facilities, this may be an unfortunate reality.

A large burden of disease exists in South Africa from HIV-infected patients; however, there is still a lack of knowledge regarding the association between HIV status and its effect on long-term outcomes in OS patients in South Africa.³ In this study, only one patient was HIV positive but virally unsuppressed and was on first-line antiretrovirals. This patient had advanced disease with lung and bone metastases at presentation and died shortly after the last chemotherapy cycle. The reasons surrounding HIV treatment failure were unfortunately unknown but presumed to be poor compliance. Other comorbidities noted were in only a few patients, and this highlights the clinical differences seen between adults, children and adolescents.

Disease characteristics

The femur and tibia were mainly affected, which is a common finding in children and adolescents.^4,7,20,26,27 Literature describes that the axial skeleton is mostly affected and associated with poorer outcomes because of limitations and complexities in surgical resection.^6,16 In this study, osteosarcoma involving uncommon anatomical sites was associated with a higher mortality rate.

Many patients were not subtyped on histological reports, and the reason for this was unknown. For these patients, only ‘osteosarcoma’ was identified, and therefore, noted in the results as not otherwise specified (NOS). Conventional OS, particularly osteoblastic, was found to be the most common, followed by telangiectatic, which is in keeping with literature.⁴

Tumour diameters were approximated using a mean diameter (average of length and width) from histological examination of the tumour, but this was carried out after neo-adjuvant chemotherapy and amputation. Five patients with tumour diameter size < 8 cm were Enneking stage 3. Two were offered limb salvage and one had a mandible resection. The two patients who had a limb salvage procedure survived. Sixteen patients with tumour diameter size ≥ 8 cm were Enneking stage 3. Twelve of them died, three relapsed and one declined surgery. Literature has shown that the size of the tumour affects the type of surgery offered. The larger the tumour, the likelihood of an amputation versus limb salvage for smaller tumours.²¹ However, in this study, most patients were offered an amputation because of the large tumour burden and locally advanced disease, which is in keeping with poorer outcomes.^5,18

All patients who died were noted to have an elevated ALP and LDH. An elevated ALP at diagnosis has shown conflicting reports in literature. Some studies indicate that it is a poor prognostic factor ^3,4,18; others have stipulated that a raised ALP is associated with a large tumour volume; however, physiological rapid bone remodelling occurs in children and adolescents, and therefore, specific ALP values need to be age-specific.²⁸ In contrast, LDH is a non-specific tumour marker, which indicates increased cell turnover. It is therefore only used as part of baseline investigations.²⁸

Investigations

Biopsies were carried out in almost all patients, which is fundamental to confirm the diagnosis.⁴ One patient had a resection carried out first because of the unusual site of the lesion in the maxilla.

Ancillary investigations to aid in the staging and management of OS were noted to be available for most patients.⁴ This could be because all these patients were treated at a tertiary unit. This is commendable considering the drawbacks seen in public facilities in a developing country like South Africa.

Outcomes and management

In both developed and developing countries, the presence of pulmonary metastases is an independent factor for prognosis, with a 5-year survival rate of 10% to 20%.^{15,16,19,20,29} In this study, the 2-year and 5-year survival rate was 45% and 28%, respectively. The 5-year survival in this study was slightly better than the above literature, although these low rates can be expected when the majority of our patients presented with metastatic disease. Most patients were Enneking stage 3 and stage 2A at diagnosis. This is in keeping with the delayed presentations seen in other studies in South Africa.^3,4,5,19 Advanced disease was the main cause of death in more than half of the patients in this study. Patients with localised disease at Enneking stage 2A did not do well either, as all patients died, with one patient refusing surgery. Enneking stage 2B had one patient refusing surgery. Other causes of death included relapse, toxicity to chemotherapy resulting in sepsis and one patient died at home with an unknown cause (Figure 3). Enneking stage 3 at presentation had mostly pulmonary metastases, which is in keeping with current literature.^{4,10,17,21,30} Metastases have been one of the main predictors of mortality in OS patients.^{9,16,18,30,31}

Because of locally advanced disease, amputation was the most common surgical procedure (Figure 1). Most patients required amputation because of large and locally advanced tumours. Limb salvage was only seen in two patients, one of whom was an astute tennis player. Both these patients were still alive, and one was known to be in remission. Limb salvage surgery requires early referrals, advanced imaging, superior surgical expertise and the presence of a viable functional limb after resection.^4,6 This is not always possible in the public sector. At the time of data collection, 35% of patients who underwent amputation were alive, with 25% in documented remission. Surgical refusal, despite comprehensive counselling efforts, remained a persistent barrier to optimal treatment in a subset of patients. The most common reason for treatment abandonment was the refusal of amputation, often driven by the belief that traditional or alternative therapies would result in a cure. In several cases, families declined surgical intervention and opted instead to pursue traditional healing practices.

Necrosis post-neoadjuvant chemotherapy is one of the main prognostic factors for outcome.^{4,6,8,20,22,26,32} In this study, patients received heterogeneous chemotherapy drugs based on availability and international evidence at the time. The majority of patients received three cycles of doxorubicin and cisplatin as neo-adjuvant chemotherapy. Only the last four patients received high-dose MAP, when the protocol had changed. Owing to chemotherapeutic availability, doxorubicin was substituted with epirubicin in one of our patients. Others had differing regimens; however, most patients had received neo-adjuvant treatment overall. Initially, the United Kingdom OS protocol – comprising only doxorubicin and cisplatin – was employed. However, as emerging literature increasingly supported the use of high-dose methotrexate (HD MTX) with improved patient outcomes, the treatment protocol was revised to adopt the MAP regimen (methotrexate, doxorubicin and cisplatin). The varied drug choices may affect accuracy when interpreting the degree of necrosis. Nevertheless, 16% of patients were Grade 3 and Grade 4, which are defined as good responders (90% – 100% necrosis). This may represent an underestimation, as the majority of patients’ histology reports were not graded.

Chemotherapy-related toxicities were managed through a multidisciplinary, supportive care approach. For gastrointestinal side effects, patients were referred early to the dietitian, with ondansetron readily available for nausea and vomiting. Diarrhoea was treated using oral rehydration solution, zinc supplementation and dietary modifications, while mucositis was managed with a standardised mouth care regimen. Myelosuppression was addressed with the use of Neupogen, broad-spectrum antibiotics and blood cultures, along with strict isolation protocols and temperature monitoring. Escalation of antibiotics was carried out when indicated, and blood and platelet transfusions were available when required. Renal toxicity was mitigated through routine pre- and post-hydration, daily monitoring of renal function and the use of renal-friendly antibiotics. Mesna was also available and used when indicated. Neurological toxicity, including severe pain, was managed with intravenous or oral morphine and gabapentin for neuropathic symptoms. In cases of pulmonary or cardiac toxicity, patients were provided with oxygen therapy, including high-flow support, and admitted to the Paediatric Intensive Care Unit (PICU) for ventilation if needed. Echocardiograms were performed as clinically indicated. Psychological and nutritional support formed a key part of care, with citalopram prescribed where appropriate, and regular input from the dietician, social worker, psychologist and on-site school support team to ensure holistic care.

Palliative chemotherapy was not utilised in this setting. Instead, medical management focused on comprehensive supportive care, including multimodal analgesia (oral morphine, paracetamol and ibuprofen), wound and mouth care, nutritional support through dietician involvement and bleeding management. Physiotherapy played a key role in maintaining patient mobility, with access to assistive devices such as crutches and wheelchairs; however, prosthetic limbs were not available. Psychosocial support was facilitated through departmental social workers, who provided counselling and engaged families throughout the care process. Advance care planning was conducted collaboratively with the social worker, the patient’s family and, where age-appropriate, the patient themselves.

Limitations

As this was a retrospective study, some data were incomplete, inaccurately recorded, or missing from the clinical files and oncology database, potentially impacting the results. The study is subject to confounding, as unmeasured variables may have influenced patient outcomes. Only data available in the database and clinical files were included. Key information, such as histology, imaging, and clinical notes, was inconsistently documented due to the use of multiple, non-integrated systems (e.g., National Health Laboratory Service [NHLS], Meditech, Picture Archiving and Communication System [PACS]), requiring additional efforts to retrieve missing data from alternative sources.

Variability in chemotherapy regimens, due to evolving treatment protocols over the study period, may have further influenced outcomes and limited comparability between patients. While outcomes were documented in the database or physical files for some patients, others required telephonic follow-up to determine survival status. Reasons for treatment abandonment were not routinely recorded; in such cases, supplementary details were provided by the unit’s social worker, who had been directly involved in patient care.

Only patients managed at this tertiary hospital were included. Survival was assessed as a binary outcome (alive or deceased) at the end of the study period. Time-to-event analysis, such as Kaplan–Meier curves or median survival estimates, was not performed, limiting the ability to assess the timing and pattern of mortality or compare survival across subgroups.

Conclusion

Osteosarcoma outcomes were poor, with 60% – 70% of our cohort succumbing to the disease. The 2-year and 5-year survival rates were 45% and 28%, respectively. Factors contributing to this poor survival included advanced disease, toxicity from chemotherapeutic agents and refusal of treatment. Data from studies like this should inform updates to current management and treatment protocols, aiming for better outcomes in future childhood and adolescent patients with OS.

Acknowledgements

The authors thank Prof. D.K. Stones for his invaluable work in creating a paediatric oncology database for the Free State and Dr O. Khaliq for her advice and assistance with this research study. This article is partially based on A.V.’s thesis entitled ‘Paediatric and Adolescent osteosarcoma: A retrospective review of the management and outcomes at a tertiary hospital in South Africa’, towards a Master’s degree, MMed (Paediatrics), in the Department of Paediatrics and Child Health, Faculty of Health Sciences, at the University of the Free State, South Africa in May 2023, supervised by Prof. Jan du Plessis.

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

A.V. was responsible for methodology, formal analysis, data curation, writing the original draft, reviewing and editing the final version of this article. J.d.P. was responsible for conceptualisation, visualisation, supervision of the study, as well as reviewing and editing the final version of this article.

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

The data generated and analysed during the current study are available from the corresponding author, A.V., upon reasonable request.

The views and opinions expressed in this article are those of the authors and are the product of professional research. The article does not necessarily reflect the official policy or position of any affiliated institution, funder, agency or the publisher. The authors are responsible for this article’s results, findings and content.

References