Osteosarcoma diagnosis and treatment at a tertiary hospital in Blantyre, Malawi: A retrospective, descriptive study

Introduction Osteosarcoma is a rare and aggressive bone malignancy that often affects children and young adults. In Malawi, osteosarcoma accounts for 2.2% of all registered bone tumors. However, little is known about the patterns of diagnosis and treatment of this disease in this setting. Delays in diagnosis and treatment may contribute to poor outcomes and survival. Therefore, this study aimed to describe the clinical features, diagnostic methods, and treatment modalities associated with osteosarcoma in Malawi. The study also investigated timelines between symptom onset, healthcare consultation, diagnosis, treatment, and outcomes. Method We conducted a retrospective review of medical records of 25 patients who were diagnosed with osteosarcoma at Queen Elizabeth Tertiary Hospital, in Blantyre- Malawi, between January 2011 and December 2016. We extracted data on patient demographics, presenting symptoms, diagnostic procedures, incisional biopsy histological findings, treatment options, and time intervals from symptom onset to first presentation at a tertiary hospital, and from diagnosis to treatment initiation. We obtained approval, to conduct study, from the College of Medicine Research and Ethics Center (COMREC) (P.02/18/2364). Results Out of 11,165 malignancies registered during the study period, 25 (0.22%) were osteosarcoma cases. The median age of the patients was 25.04 years (SD +/-11) with an equal sex distribution. The most common presenting symptoms were pain (100%) and swelling (92%). The median duration from symptom onset to first visit at tertiary hospital being 8.5 months and time of diagnosis to treatment with a median duration of 16.5 days. The diagnosis was confirmed by histology in 14 (56%) cases and by radiography in 11 (44%) cases. No tumor grade was recorded in the histology reports. The treatment carried out included amputation (48%), palliative care (symptom supportive care) (32%), limb salvage surgery (4%), and neoadjuvant chemotherapy (4%). Three patients (12%) refused amputation. No patient received adjuvant chemotherapy. Conclusion Osteosarcoma is a challenging disease to diagnose and treat in Malawi due to its rarity, nonspecific symptoms, lack of histological grading and staging, limited treatment options, and long delays in the care pathway. There is a need for increased awareness and suspicion among primary health care providers, improved access to diagnostic facilities and specialized care, and multidisciplinary collaboration to optimize the management and prognosis of osteosarcoma patients in this setting.