Purpose. It is assumed that osteosarcomas of the jaws mainly occur at older ages, whereas the most prominent sites, that is, the long bones, are more affected at ages <20. Jaw-localized tumors are less malignant and have lower metastatic spread rates. Patients and Methods. This study analyses the nationwide data of the Dutch Cancer Registry on osteosarcoma during the period from 1991 to 2010. Age-corrected incidence rates were calculated. Results. In 949, 38 patients had tumors in the maxilla and in 58 in the mandible. Median age for maxilla, mandible, and other localizations was 45.5, 49, and 23 years, respectively. Age-corrected incidence for osteosarcomas increased after a steep decline for the age cohorts from 20 to 60 years to nearly the same level as the younger patients. The incidence for maxillary lesions showed a steady increase from 0.46 to 1.60 per million over all age ranges; the highest incidence for mandibular lesions was found in the age cohort from 60 to 79 years. In respect to histology, no shifts for age were found, except for Paget’s disease-related osteosarcoma. In older patients, chemotherapy was omitted more often. Overall survival was similar for all age groups, except for extragnatic tumor patients in the age range of 60–79 years. Conclusions. Osteosarcomas have comparable incidences below the age of 20 as compared with ages >60 years. Poorer outcome in older people is likely due to refraining from chemotherapy. 1. Introduction Osteosarcoma is the most common malignancy of bone. Based on location of the tumor differences in occurrence, clinical behavior and outcome are assumed. This is especially the case for osteosarcoma of the maxilla and mandible. These locations are presumed to be rare. Percentages of 1 to 9% of the total number of osteosarcomas are mentioned [1–5]. It is further claimed that the mean age of presentation of craniofacial osteosarcomas is at least 10 to 15 years later than osteosarcomas in other parts of the body. However, reports are based on data sources from single institutions or are compiled from registries [4, 6–11]. It is further claimed that tumors in mandible and maxilla are less malignant as based on more often occurrence of low malignant histology and in particular on clinical outcome, that is, a better event, and overall prognosis, and lower incidence of metastatic spread as compared with osteosarcomas arising elsewhere in the body. Metastatic spread at initial presentation up to 16% is reported [3, 7, 11–16]. In this paper the nationwide data on osteosarcomas, as registered by the Netherlands,
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