title: Osteosarcoma of the hand and forearm: experience of the Cooperative Osteosarcoma Study Group.
abstract: BACKGROUND
  Osteosarcoma is extremely rare in the hand and forearm. Therefore, only limited data are available for planning treatment or predicting the outcome and prognosis of osteosarcoma in the peripheral upper extremity.
  
  
  METHODS
  Epidemiological, clinical, and histopathologic data were analyzed in 39 patients with osteosarcoma of the forearm or hand who were enrolled in studies of the Cooperative German-Austrian-Swiss Osteosarcoma Study Group from 1977 to December 2000. In patients with high-grade osteosarcoma, the treatment entailed surgical resection in combination with chemotherapy, whereas patients with low-grade osteosarcoma underwent only surgery.
  
  
  RESULTS
  The 5-year overall survival rate among the 33 patients with high-grade central osteosarcoma of the distal upper extremity was 86.2% +/- 6.4%. The 5-year event-free survival rate was 65.4% +/- 9.6%. Five of the eight patients with secondary metastases were in remission at the time of analysis. Four patients died of their disease, and two patients died of chemotherapy-related complications. The mean overall survival rate was 88.0% +/- 6.5% in patients treated by wide or radical tumor resection and was 75.0% +/- 21.7% in patients with nonwide margins of resection. Whether amputation or local resection was performed had no significant influence on the prognosis. All six patients whose osteosarcoma was not classified as high-grade central osteosarcoma were in remission at the time of analysis.
  
  
  CONCLUSIONS
  The results demonstrate a remarkably high survival rate for patients with high-grade osteosarcoma of the hand and forearm and confirm that multiagent chemotherapy in combination with wide excision is a highly effective treatment for this malignant tumor.
authors.affiliation: Department of Hand Surgery, University of Heidelberg, Schlierbacher Landstrasse 200, 69118, Heidelberg, Germany. coss@uni-muenster.de
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Daecke
authors.forename: Stefan
authors.initials: S
authors.lastname: Bielack
authors.forename: Abdul-Kader
authors.initials: AK
authors.lastname: Martini
authors.forename: Volker
authors.initials: V
authors.lastname: Ewerbeck
authors.forename: Heribert
authors.initials: H
authors.lastname: Jürgens
authors.forename: Rainer
authors.initials: R
authors.lastname: Kotz
authors.forename: Winfried
authors.initials: W
authors.lastname: Winkelmann
authors.forename: Hartmut
authors.initials: H
authors.lastname: Kabisch
authors.forename: Matthias
authors.initials: M
authors.lastname: Kevric
authors.forename: Ludger
authors.initials: L
authors.lastname: Bernd
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical; D000971:Antineoplastic Combined Chemotherapy Protocols; D001859:Bone Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D016025:Bone Transplantation; D001133:Bones of Upper Extremity; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005542:Forearm; D005858:Germany / Q000453:epidemiology; D006225:Hand; D006801:Humans; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D015996:Survival Rate