title: Nonmetastatic osteosarcoma of the extremity with pathologic fracture at presentation: local and systemic control by amputation or limb salvage after preoperative chemotherapy.
abstract: To determine whether a pathologic fracture in osteosarcoma of long bones has prognostic importance, and limb salvage can be safely performed in such cases, we reviewed the surgical treatment and oncologic results in 46 patients with nonmetastatic osteosarcoma of the extremity and pathologic fracture at presentation who had been treated in our Institution with neoadjuvant chemotherapy, between 1983 and 1999. Neoadjuvant chemotherapy was given according to 6 consecutive protocols. Surgery consisted of limb salvage (34 patients), amputation (11 patients) and rotationplasty (1 patient). The average follow-up was 11 (3-20) years. 28 patients remained continuously disease-free, 17 patients relapsed and 1 died of chemotherapy-related toxicity. Despite the high rate of limb salvage, only 2 local failures occurred, 1 after amputation and 1 after limb salvage. The 5-year disease-free survival and overall survival rates were 59% and 65%, respectively, with no differences between amputated and resected patients. These results are similar to those obtained in 689 contemporary patients having an osteosarcoma without a pathologic fracture treated in our Institution, and using the same protocols for chemotherapy. We conclude that with neoadjuvant chemotherapy, osteosarcoma patients presenting with a pathologic fracture can be surgically treated like those with no fracture, and that limb salvage procedures do not increase the risk of local recurrence or death of these patients.
authors.affiliation: Department of Musculoskeletal Oncology of the Rizzoli Orthopaedic Institute, Bologna, Italy. gaetano.bacci@ior.it
authors.forename: Gaetano
authors.initials: G
authors.lastname: Bacci
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferrari
authors.forename: Alessandra
authors.initials: A
authors.lastname: Longhi
authors.forename: Davide
authors.initials: D
authors.lastname: Donati
authors.forename: Marco
authors.initials: M
authors.lastname: Manfrini
authors.forename: Stefano
authors.initials: S
authors.lastname: Giacomini
authors.forename: Antonio
authors.initials: A
authors.lastname: Briccoli
authors.forename: Cristiana
authors.initials: C
authors.lastname: Forni
authors.forename: Stefano
authors.initials: S
authors.lastname: Galletti
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical / Q000379:methods; D001859:Bone Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D002648:Child; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007558:Italy; D023821:Limb Salvage / Q000379:methods; D035002:Lower Extremity; D008297:Male; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D016896:Treatment Outcome; D034941:Upper Extremity