Survival rate of pediatric osteosarcoma in Indonesia: a single center study

  • Hikari Ambara Sjakti Cipto Mangunkusumo Hospital
  • Isyanaditta Agung Putri Cipto Mangunkusumo Hospital
  • Endang Windiastuti Cipto Mangunkusumo Hospital
Keywords: childhood osteosarcoma, survival rate, low-middle income countries


Background Over the years, the survival rate of children with osteosarcoma has increased with improved management. However, survival tends to be lower in low-middle-income countries.

Objective To report the survival rate of children with osteosarcoma in a single center in Indonesia and to evaluate the outcomes of treatment modalities currently used.

Methods We performed a retrospective analysis of the medical records of pediatric osteosarcoma patients in Cipto Mangunkusumo Hospital from 2015 to 2019. Patients were categorized based on age group, sex, primary tumor location, treatment modalities, disease metastasis, and disease outcome.

Results We included 83 children with osteosarcoma, with an age range of 4-17 years (median 13 years). Mean estimated overall survival and event-free survival were 28 (95%CI 24 to 32) months and 10 (95%CI 8 to 13) months, respectively. Overall survival duration between treatment modality groups was significantly different (P<0.05). The mean estimated overall duration of survival was 9 (95%CI 3 to 15) months for chemotherapy, 18 (95%CI 14 to 22) months for chemotherapy with surgery, and 21 (95%CI 14 to 27) months for chemotherapy with surgery and radiation.

Conclusion The survival rate of childhood osteosarcoma in Indonesia remains low. The current treatment option currently used in our center may contribute to the low rate of survival.


Author Biographies

Hikari Ambara Sjakti, Cipto Mangunkusumo Hospital

Pediatric Consultant in Pediatric Hemato-Oncology Department, Cipto Mangunkusumo Hospital

Endang Windiastuti, Cipto Mangunkusumo Hospital

Pediatric Consultant in Pediatric Hemato-Oncology Department, Cipto Mangunkusumo Hospital


1. Durfee RA, Mohammed M, Luu HH. Review of osteosarcoma and current management. Rheumatol Ther. 2016;3:221–43. DOI: 10.1007/s40744-016-0046-y.
2. Zhang Y, Yang J, Zhao N, Wang C, Kamar S, Zhou Y, et al. Progress in the chemotherapeutic treatment of osteosarcoma. Oncol Lett. 2018;16:6228–37. DOI: 10.3892/ol.2018.9434.
3. Kamal AF, Widyawarman H, Husodo K, Hutagalung EU, Rajabto W. Clinical outcome and survival of osteosarcoma patients in Cipto Mangunkusumo Hospital: limb salvage surgery versus amputation. Acta Med Indones. 2016;48:175–83. PMID: 27840351.
4. Lindsey BA, Markel JE, Kleinerman ES. Osteosarcoma overview. Rheumatol Ther. 2017;4:25–43. DOI: 10.1007/s40744-016-0050-2.
5. Taran SJ, Taran R, Malipatil NB. Pediatric osteosarcoma: an updated review. Indian J Med Paediatr Oncol. 2017;38:33–43. DOI: 10.4103/0971-5851.203513.
6. Spraker-Perlman HL, Barkauskas DA, Krailo MD, Meyers A, Schwartz CL, Doski J, et al. Factors influencing survival after recurrence in osteosarcoma: a report from the Children's Oncology Group. Pediatr Blood Cancer. 2019;66:e27444. DOI: 10.1002/pbc.27444.
7. Erdmann F, Frederiksen LE, Bonaventure A, Mader L, Hasle H, Robison LL, et al. Childhood cancer: survival, treatment modalities, late effects and improvements over time. Cancer Epidemiol. 2021;71:101733. DOI: 10.1016/j.canep.2020.101733.
8. Wu J. Increased survival of patients aged 0-29 years with osteosarcoma?: A period analysis , 1984. 2018:3652–61. DOI: 10.1002/cam4.1659
9. Bhakta N, Force LM, Allemani C, Atun R, Bray F, Coleman MP, et al. Childhood cancer burden: a review of global estimates. Lancet Oncol. 2019;20:e42–53. DOI: 10.1016/S1470-2045(18)30761-7.
10. Fung A, Horton S, Zabih V, Denburg A, Gupta S. Cost and cost-effectiveness of childhood income and cancer treatment in low-income countries: a systematic review. BMJ Glob Health. 2019;4:e001825. DOI: 10.1136/bmjgh-2019-001825.
11. Pruksakorn D, Phanphaisarn A, Arpornchayanon O, Uttamo N, Leerapun T, settakorn J. Survival rate and prognostic factors of conventional osteosarcoma in Northern Thailand: a series from Chiang Mai University Hospital. Cancer Epidemiol. 2015;39:956–63. DOI: 10.1016/j.canep.2015.10.016.
12. Wiromrat P, Jetsrisuparb A, Komvilaisak P, Sirichativapee W, Kamsa-ard S, Wiangnon S. Incidence and survival rates among pediatric osteogenic sarcoma cases in Khon Kaen, Thailand, 1985-2010. Asian Pac J Cancer Prev [Internet]. 2012 [cited 2021 Nov 12];13(9):4281–4. DOI: 10.7314/APJCP.2012.13.9.4281
13. Vasquez L, Silva J, Chavez S, Zapata A, Diaz R, Tarrillo F, et al. Prognostic impact of diagnostic and treatment delays in children with osteosarcoma. Pediatr Blood Cancer. 2020;67:e28180. DOI: 10.1002/pbc.28180.
14. Magrath I, Steliarova-Foucher E, Epelman S, Ribeiro RC, Harif M, Li CK, et al. Paediatric cancer in low-income and middle-income countries. Lancet Oncol. 2013 Mar 1;14(3):e104–16. DOI: 10.1016/S1470-2045(13)70008-1
15. Ding WZ, Liu K, Li Z, Chen SR. A meta-analysis of prognostic factors of osteosarcoma. Eur Rev Med Pharmacol Sci. 2020;24:4103-12. DOI: 10.26355/eurrev_202004_20989.
How to Cite
Sjakti H, Putri I, Windiastuti E. Survival rate of pediatric osteosarcoma in Indonesia: a single center study. PI [Internet]. 29Dec.2021 [cited 30Nov.2023];62(1):27-1. Available from:
Pediatric Hemato-Oncology
Received 2020-11-30
Accepted 2021-12-29
Published 2021-12-29