Endoprosthetic replacement for stage IIB osteosarcoma.
Over an eight-year period, 100 patients with IIB osteosarcoma have been managed. Eighty-one were treated with limb-salvage procedures, 78 of which involved reconstruction utilizing endoprostheses. Only 19 patients received amputation as the primary treatment for local control. Since 1984, all patients received preoperative and post-operative adjuvant chemotherapy. Those patients who received chemotherapy had a statistically significant improvement in five-year survival over those who did not (57% and 32%, respectively, p = 0.014). The functional results were good overall, with excellent results seen in distal femoral reconstruction. Twenty-eight of the 78 patients treated with endoprosthetic reconstruction experienced 30 complications (36%). Mechanical failure was the most common complication (10%) but was generally correctable. The local recurrence rate was 5% and the infection rate was 3%. Local complications were manageable. A statistical analysis revealed that the relative risk of patient death was 2.5 times higher than prosthesis failure for the 78 patients with endoprosthetic reconstruction. The intermediate-term results, with a median follow-up period of 43 months, remains encouraging.
Eckardt
J J
JJ
Department of Surgery, UCLA Center for the Health Services.
Eilber
F R
FR
Rosen
G
G
Mirra
J M
JM
Dorey
F J
FJ
Ward
W G
WG
Kabo
J M
JM
D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical / Q000534:rehabilitation*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011183:Postoperative Complications / Q000453:epidemiology; D019736:Prostheses and Implants / Q000592:standards*; D011878:Radiotherapy / Q000592:standards; D016059:Range of Motion, Articular; D016019:Survival Analysis; D015996:Survival Rate