Aim: To assess the outcome and determine predictors of survival in pediatric patients with osteosarcoma of the extremities treated with a unified chemotherapy protocol at a single institution over a fifteen-year period. Methods: We performed a retrospective analysis of medical records of 48 pediatric patients with histologically-verified osteosarcoma of the extremities diagnosed at South Egypt Cancer Institute and received treatment between January 2001 and December 2015. Results: With a median follow-up of 61 months for the entire cohort, estimates of Overall Survival (OS) for 3 and 5-year were 50.9% & 42.1%, respectively. While the estimates of OS for 3 and 5-year in the non-metastatic group were 79% & 65.2%, respectively. In the multivariable analysis, both metastatic disease at diagnosis and poor response to chemotherapy retained their statistical significance as independent predictors for Event Free Survival (EFS). Whereas for OS, a metastatic disease at diagnosis remained as the lone predictor of a dismal outcome, whilst a poor response to chemotherapy became marginally associated with an inferior outcome. Conclusion: In Upper Egypt, whereas slightly less than two-thirds of children with localized osteosarcoma of extremities survives their disease, metastasis at presentation remains the key predictor of dismal survival outcomes.

Aim: To assess the outcome and determine predictors of survival in pediatric patients with osteosarcoma of the extremities treated with a unified chemotherapy protocol at a single institution over a fifteen-year period. Methods: We performed a retrospective analysis of medical records of 48 pediatric patients with histologically-verified osteosarcoma of the extremities diagnosed at South Egypt Cancer Institute and received treatment between January 2001 and December 2015. Results: With a median follow-up of 61 months for the entire cohort, estimates of Overall Survival (OS) for 3 and 5-year were 50.9% & 42.1%, respectively. While the estimates of OS for 3 and 5-year in the non-metastatic group were 79% & 65.2%, respectively. In the multivariable analysis, both metastatic disease at diagnosis and poor response to chemotherapy retained their statistical significance as independent predictors for Event Free Survival (EFS). Whereas for OS, a metastatic disease at diagnosis remained as the lone predictor of a dismal outcome, whilst a poor response to chemotherapy became marginally associated with an inferior outcome. Conclusion: In Upper Egypt, whereas slightly less than two-thirds of children with localized osteosarcoma of extremities survives their disease, metastasis at presentation remains the key predictor of dismal survival outcomes.

Aim: To assess the outcome and determine predictors of survival in pediatric patients with osteosarcoma of the extremities treated with a unified chemotherapy protocol at a single institution over a fifteen-year period. Methods: We performed a retrospective analysis of medical records of 48 pediatric patients with histologically-verified osteosarcoma of the extremities diagnosed at South Egypt Cancer Institute and received treatment between January 2001 and December 2015. Results: With a median follow-up of 61 months for the entire cohort, estimates of Overall Survival (OS) for 3 and 5-year were 50.9% & 42.1%, respectively. While the estimates of OS for 3 and 5-year in the non-metastatic group were 79% & 65.2%, respectively. In the multivariable analysis, both metastatic disease at diagnosis and poor response to chemotherapy retained their statistical significance as independent predictors for Event Free Survival (EFS). Whereas for OS, a metastatic disease at diagnosis remained as the lone predictor of a dismal outcome, whilst a poor response to chemotherapy became marginally associated with an inferior outcome. Conclusion: In Upper Egypt, whereas slightly less than two-thirds of children with localized osteosarcoma of extremities survives their disease, metastasis at presentation remains the key predictor of dismal survival outcomes.

Aim: To assess the outcome and determine predictors of survival in pediatric patients with osteosarcoma of the extremities treated with a unified chemotherapy protocol at a single institution over a fifteen-year period. Methods: We performed a retrospective analysis of medical records of 48 pediatric patients with histologically-verified osteosarcoma of the extremities diagnosed at South Egypt Cancer Institute and received treatment between January 2001 and December 2015. Results: With a median follow-up of 61 months for the entire cohort, estimates of Overall Survival (OS) for 3 and 5-year were 50.9% & 42.1%, respectively. While the estimates of OS for 3 and 5-year in the non-metastatic group were 79% & 65.2%, respectively. In the multivariable analysis, both metastatic disease at diagnosis and poor response to chemotherapy retained their statistical significance as independent predictors for Event Free Survival (EFS). Whereas for OS, a metastatic disease at diagnosis remained as the lone predictor of a dismal outcome, whilst a poor response to chemotherapy became marginally associated with an inferior outcome. Conclusion: In Upper Egypt, whereas slightly less than two-thirds of children with localized osteosarcoma of extremities survives their disease, metastasis at presentation remains the key predictor of dismal survival outcomes.

Aim: To assess the outcome and determine predictors of survival in pediatric patients with osteosarcoma of the extremities treated with a unified chemotherapy protocol at a single institution over a fifteen-year period. Methods: We performed a retrospective analysis of medical records of 48 pediatric patients with histologically-verified osteosarcoma of the extremities diagnosed at South Egypt Cancer Institute and received treatment between January 2001 and December 2015. Results: With a median follow-up of 61 months for the entire cohort, estimates of Overall Survival (OS) for 3 and 5-year were 50.9% & 42.1%, respectively. While the estimates of OS for 3 and 5-year in the non-metastatic group were 79% & 65.2%, respectively. In the multivariable analysis, both metastatic disease at diagnosis and poor response to chemotherapy retained their statistical significance as independent predictors for Event Free Survival (EFS). Whereas for OS, a metastatic disease at diagnosis remained as the lone predictor of a dismal outcome, whilst a poor response to chemotherapy became marginally associated with an inferior outcome. Conclusion: In Upper Egypt, whereas slightly less than two-thirds of children with localized osteosarcoma of extremities survives their disease, metastasis at presentation remains the key predictor of dismal survival outcomes.

NULLTo assess the postoperative analgesic efficacy of epidural dexmedetomidine added to bupivacaine infusion for patients undergoing major abdominal cancer surgery. Methods: Patients scheduled for major upper abdominal cancer surgery were allocated to group bupivacaine (n =32), in which patients received epidural bupivacaine infusion (6 mL/h bupivacaine 0.1%) for 48 hours postoperatively, or group bupivacaine + dexmedetomidine )=32), in which patients received epidural dexmedetomidine added to bupivacaine infusion (6 mL/ of bupivacaine 0.1% + dexmedetomidine, 0.5 μg/mL) for 48 hours postoperatively. The cumulative morphine consumption, the time to first analgesic request, and the VAS painةscore were evaluated. Results: The cumulative morphine consumption was significantly reduced in group bupivacaine+ dexmedetomidine compared with group bupivacaine: mean ± SD of 10.40±5.16 mg vs23.23±8.37mg with an estimated difference (95% CI) of –12.83 (−16.43, –9.24), (P0.001(.The time to the first analgesic demand was significantly delayed in group bupivacaine + dexmedetomidine compared with group bupivacaine: median (IQR) of 6 (1.75, 8.25) h vs 1 (0, 4)h, P0.001). The mean collapsed over time of overall VAS pain scores at rest and movement was significantly reduced in group bupivacaine + dexmedetomidine compared with group bupivacaine:mean ± SE of 1.6±0.08 vs 2.38±0.08 with an estimated difference (95% CI) of −0.8(−1, –0.86), (P0.001), and mean ± SE of 2.17±0.07 vs 3.25±0.07 with an estimated difference(95% CI) of −1.1 (−1.27, – 0.89), (P0.001), respectively. Conclusion: Epidural infusion of dexmedetomidine added to bupivacaine for patients undergoing major abdominal cancer surgery significantly reduced morphine consumption, delayed time to first analgesic supplementation, and decreased pain intensity during the first 48 hours postoperatively without harmful derangement on hemodynamics.

NULLTo assess the postoperative analgesic efficacy of epidural dexmedetomidine added to bupivacaine infusion for patients undergoing major abdominal cancer surgery. Methods: Patients scheduled for major upper abdominal cancer surgery were allocated to group bupivacaine (n =32), in which patients received epidural bupivacaine infusion (6 mL/h bupivacaine 0.1%) for 48 hours postoperatively, or group bupivacaine + dexmedetomidine )=32), in which patients received epidural dexmedetomidine added to bupivacaine infusion (6 mL/ of bupivacaine 0.1% + dexmedetomidine, 0.5 μg/mL) for 48 hours postoperatively. The cumulative morphine consumption, the time to first analgesic request, and the VAS painةscore were evaluated. Results: The cumulative morphine consumption was significantly reduced in group bupivacaine+ dexmedetomidine compared with group bupivacaine: mean ± SD of 10.40±5.16 mg vs23.23±8.37mg with an estimated difference (95% CI) of –12.83 (−16.43, –9.24), (P0.001(.The time to the first analgesic demand was significantly delayed in group bupivacaine + dexmedetomidine compared with group bupivacaine: median (IQR) of 6 (1.75, 8.25) h vs 1 (0, 4)h, P0.001). The mean collapsed over time of overall VAS pain scores at rest and movement was significantly reduced in group bupivacaine + dexmedetomidine compared with group bupivacaine:mean ± SE of 1.6±0.08 vs 2.38±0.08 with an estimated difference (95% CI) of −0.8(−1, –0.86), (P0.001), and mean ± SE of 2.17±0.07 vs 3.25±0.07 with an estimated difference(95% CI) of −1.1 (−1.27, – 0.89), (P0.001), respectively. Conclusion: Epidural infusion of dexmedetomidine added to bupivacaine for patients undergoing major abdominal cancer surgery significantly reduced morphine consumption, delayed time to first analgesic supplementation, and decreased pain intensity during the first 48 hours postoperatively without harmful derangement on hemodynamics.

NULLTo assess the postoperative analgesic efficacy of epidural dexmedetomidine added to bupivacaine infusion for patients undergoing major abdominal cancer surgery. Methods: Patients scheduled for major upper abdominal cancer surgery were allocated to group bupivacaine (n =32), in which patients received epidural bupivacaine infusion (6 mL/h bupivacaine 0.1%) for 48 hours postoperatively, or group bupivacaine + dexmedetomidine )=32), in which patients received epidural dexmedetomidine added to bupivacaine infusion (6 mL/ of bupivacaine 0.1% + dexmedetomidine, 0.5 μg/mL) for 48 hours postoperatively. The cumulative morphine consumption, the time to first analgesic request, and the VAS painةscore were evaluated. Results: The cumulative morphine consumption was significantly reduced in group bupivacaine+ dexmedetomidine compared with group bupivacaine: mean ± SD of 10.40±5.16 mg vs23.23±8.37mg with an estimated difference (95% CI) of –12.83 (−16.43, –9.24), (P0.001(.The time to the first analgesic demand was significantly delayed in group bupivacaine + dexmedetomidine compared with group bupivacaine: median (IQR) of 6 (1.75, 8.25) h vs 1 (0, 4)h, P0.001). The mean collapsed over time of overall VAS pain scores at rest and movement was significantly reduced in group bupivacaine + dexmedetomidine compared with group bupivacaine:mean ± SE of 1.6±0.08 vs 2.38±0.08 with an estimated difference (95% CI) of −0.8(−1, –0.86), (P0.001), and mean ± SE of 2.17±0.07 vs 3.25±0.07 with an estimated difference(95% CI) of −1.1 (−1.27, – 0.89), (P0.001), respectively. Conclusion: Epidural infusion of dexmedetomidine added to bupivacaine for patients undergoing major abdominal cancer surgery significantly reduced morphine consumption, delayed time to first analgesic supplementation, and decreased pain intensity during the first 48 hours postoperatively without harmful derangement on hemodynamics.

NULLTo assess the postoperative analgesic efficacy of epidural dexmedetomidine added to bupivacaine infusion for patients undergoing major abdominal cancer surgery. Methods: Patients scheduled for major upper abdominal cancer surgery were allocated to group bupivacaine (n =32), in which patients received epidural bupivacaine infusion (6 mL/h bupivacaine 0.1%) for 48 hours postoperatively, or group bupivacaine + dexmedetomidine )=32), in which patients received epidural dexmedetomidine added to bupivacaine infusion (6 mL/ of bupivacaine 0.1% + dexmedetomidine, 0.5 μg/mL) for 48 hours postoperatively. The cumulative morphine consumption, the time to first analgesic request, and the VAS painةscore were evaluated. Results: The cumulative morphine consumption was significantly reduced in group bupivacaine+ dexmedetomidine compared with group bupivacaine: mean ± SD of 10.40±5.16 mg vs23.23±8.37mg with an estimated difference (95% CI) of –12.83 (−16.43, –9.24), (P0.001(.The time to the first analgesic demand was significantly delayed in group bupivacaine + dexmedetomidine compared with group bupivacaine: median (IQR) of 6 (1.75, 8.25) h vs 1 (0, 4)h, P0.001). The mean collapsed over time of overall VAS pain scores at rest and movement was significantly reduced in group bupivacaine + dexmedetomidine compared with group bupivacaine:mean ± SE of 1.6±0.08 vs 2.38±0.08 with an estimated difference (95% CI) of −0.8(−1, –0.86), (P0.001), and mean ± SE of 2.17±0.07 vs 3.25±0.07 with an estimated difference(95% CI) of −1.1 (−1.27, – 0.89), (P0.001), respectively. Conclusion: Epidural infusion of dexmedetomidine added to bupivacaine for patients undergoing major abdominal cancer surgery significantly reduced morphine consumption, delayed time to first analgesic supplementation, and decreased pain intensity during the first 48 hours postoperatively without harmful derangement on hemodynamics.

NULLTo assess the postoperative analgesic efficacy of epidural dexmedetomidine added to bupivacaine infusion for patients undergoing major abdominal cancer surgery. Methods: Patients scheduled for major upper abdominal cancer surgery were allocated to group bupivacaine (n =32), in which patients received epidural bupivacaine infusion (6 mL/h bupivacaine 0.1%) for 48 hours postoperatively, or group bupivacaine + dexmedetomidine )=32), in which patients received epidural dexmedetomidine added to bupivacaine infusion (6 mL/ of bupivacaine 0.1% + dexmedetomidine, 0.5 μg/mL) for 48 hours postoperatively. The cumulative morphine consumption, the time to first analgesic request, and the VAS painةscore were evaluated. Results: The cumulative morphine consumption was significantly reduced in group bupivacaine+ dexmedetomidine compared with group bupivacaine: mean ± SD of 10.40±5.16 mg vs23.23±8.37mg with an estimated difference (95% CI) of –12.83 (−16.43, –9.24), (P0.001(.The time to the first analgesic demand was significantly delayed in group bupivacaine + dexmedetomidine compared with group bupivacaine: median (IQR) of 6 (1.75, 8.25) h vs 1 (0, 4)h, P0.001). The mean collapsed over time of overall VAS pain scores at rest and movement was significantly reduced in group bupivacaine + dexmedetomidine compared with group bupivacaine:mean ± SE of 1.6±0.08 vs 2.38±0.08 with an estimated difference (95% CI) of −0.8(−1, –0.86), (P0.001), and mean ± SE of 2.17±0.07 vs 3.25±0.07 with an estimated difference(95% CI) of −1.1 (−1.27, – 0.89), (P0.001), respectively. Conclusion: Epidural infusion of dexmedetomidine added to bupivacaine for patients undergoing major abdominal cancer surgery significantly reduced morphine consumption, delayed time to first analgesic supplementation, and decreased pain intensity during the first 48 hours postoperatively without harmful derangement on hemodynamics.