title: Relationship of chemotherapy-induced necrosis and surgical margins to local recurrence in osteosarcoma.
abstract: OBJECTIVE
  To assess patients with high-grade osteosarcoma treated at our institution for various prognostic factors for the development of local recurrence of disease. Follow-up data were available for all patients and the mean follow-up duration was 65 months in surviving patients.
  
  
  RESULTS
  There were 28 local recurrences in this study (7%). Of these, only three patients (11%) were alive at the most recent follow-up point, 28, 53, and 54 months after local recurrence. None of 59 patients who were treated primarily with a radical amputation and none of 10 who underwent a rotationplasty developed local recurrence. Four of 48 patients (8%) who had wide amputations, one of whom had an intralesional amputation, and 23 of 237 (10%) who had limb-salvage surgery developed locally recurrent disease. Of 237 patients who underwent limb-sparing resection, three prognostic factors for local control were identified. The strongest association with local recurrence was chemotherapy response (P < .0001), followed closely by surgical margins (P = .0001). Older patients were more likely to have locally recurrent disease (P = .033), with each decade of life older than the first decade having a relative risk of 1.5 times greater per decade (SE = 0.16; 95% confidence interval, 0.034 to .0650). Factors that were not associated with local recurrence included sex, date of diagnosis, and anatomic site of disease.
  
  
  CONCLUSIONS
  Chemotherapy-induced tumor necrosis and surgical margins are important prognostic factors for local control of patients with osteosarcoma.
authors.affiliation: Laboratory for Oncology Research, Rizzoli Institute, Bologna, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Picci
authors.forename: L
authors.initials: L
authors.lastname: Sangiorgi
authors.forename: B T
authors.initials: BT
authors.lastname: Rougraff
authors.forename: J R
authors.initials: JR
authors.lastname: Neff
authors.forename: R
authors.initials: R
authors.lastname: Casadei
authors.forename: M
authors.initials: M
authors.lastname: Campanacci
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000671:Amputation, Surgical / Q000379:methods; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009336:Necrosis / Q000139:chemically induced; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology*; D012516:Osteosarcoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis