Cancer Treatment / LEARNING CURVE
more than 50% of treated animals within 1 year and in more than 90% within 3 years. Predictive factors, which are simi- lar for dogs and people, include age at diagnosis; anatomic location and size of the tumor; histologic grade; serum alka- line phosphatase concentrations; and ini- tial response to therapy. Without treatment, affected dogs usu-
ally live more than 10 weeks. Palliative treatment controls the pain associated with the disease, but does not extend survival. Amputation increases survival to about 5 to 7 months. The standard of care includes amputa-
tion or limb-sparing surgery followed by adjuvant chemotherapy to delay growth of micrometastases, which are invari- ably present by the time the disease is diagnosed. The reported range for median overall
survival is about 6 to 11 months, with less than 30% of dogs surviving 2 years and less than 10% surviving 3 years. There is no difference in survival among the three most common histologic tumor subtypes (osteoblastic, chondroblastic and fibro- blastic osteosarcoma). Although the survival statistics are
discouraging, it is useful to compare these data with the results of children with bone cancer (the highest-risk group in people). In children, the standard of care produces an overall survival rate of about 80%, but event-free survival is lower (about 60% at 5 years) and only about 50% will survive 10 years. This means that 20% of children diagnosed with osteosarcoma will not survive 5 years, as many as 50% may not see the 10th anniversary of their diagnosis, and most have significant morbidity associ- ated with the disease. The timeframe bracketed by these hallmarks in children represents about 10% of an average adult lifetime, which provides a reasonable basis on which to compare the best clinical outcome with dogs that have bone tumors, indicating that, at least at present, the outcomes for osteosarcoma patients, whether human
Trends magazine, April 2013
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alleycat.org/Veterinarian.
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