Cortical allograft and endoprosthesis for limb-sparing surgery in dogs with distal radial osteosarcoma: a prospective clinical comparison of two different limb-sparing techniques.
OBJECTIVE
To compare surgical and oncologic outcome in dogs with osteosarcoma (OSA) of the distal aspect of the radius treated with limb-sparing surgery, using either a cortical allograft or endoprosthesis, and postoperative chemotherapy; and to evaluate predictive factors for outcome.


METHODS
Prospective cohort study.


METHODS
Dogs (n = 20) with spontaneous, non-metastatic OSA of the distal aspect of the radius.


METHODS
Dogs were prospectively randomized for limb-sparing surgery with either a cortical allograft (n = 10) or endoprosthesis (10) and full-course adjuvant chemotherapy using single or dual agent protocols of cisplatin, carboplatin, and/or doxorubicin. Surgical (intraoperative findings, postoperative infection, construct failure) and oncologic (local tumor recurrence, metastasis, survival) outcomes were compared. The influence of intraoperative and postoperative variables on surgical and oncologic outcome were evaluated.


RESULTS
No clinically significant differences in surgical and oncologic outcome were detected between groups. The percentage of radius replaced by the implant was significantly greater in the endoprosthesis group (60.9% compared with 48.6%, P = .008). Median survival time (MST) for dogs with construct failure, regardless of implant type, was 685 days and significantly greater than MST of dogs without construct failure (322 days, P = .042; hazard ratio [HR] 16.82). Median metastasis-free interval and MST (685 days versus 289 days; P = .034, HR 24.58) were significantly greater in dogs with postoperative infection. Disease-free and overall limb-salvage rates were 70% and 85%, respectively. Overall MST was 430 days.


CONCLUSIONS
For dogs with OSA of the distal aspect of the radius, a cortical allograft or endoprosthesis can be used for limb-sparing surgery. Construct failure and postoperative infection significantly improve survival time regardless of implant type.


CONCLUSIONS
An endoprosthesis is an attractive alternative to cortical allografts for limb-salvage of the distal aspect of the radius in dogs because surgical and oncologic outcomes are similar, but the endoprosthesis is an immediately available off-the-shelf implant which is not complicated by the bone harvesting and banking requirements associated with cortical allografts. Mechanisms whereby postoperative infection improves survival time requires further investigation and, if elucidated, may provide the opportunity to improve the outcome of dogs and humans with OSA.
Liptak
Julius M
JM
Animal Cancer Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, USA.
Dernell
William S
WS
Ehrhart
Nicole
N
Lafferty
Mary H
MH
Monteith
Gabrielle J
GJ
Withrow
Stephen J
SJ
D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000601:surgery / Q000628:therapy / Q000662:veterinary*; D016025:Bone Transplantation; D015331:Cohort Studies; D018572:Disease-Free Survival; D004283:Dog Diseases / Q000188:drug therapy / Q000601:surgery* / Q000628:therapy; D004285:Dogs; D009364:Neoplasm Recurrence, Local / Q000662:veterinary; D012516:Osteosarcoma / Q000601:surgery / Q000628:therapy / Q000662:veterinary*; D011183:Postoperative Complications / Q000453:epidemiology / Q000662:veterinary; D011446:Prospective Studies; D019736:Prostheses and Implants / Q000662:veterinary*; D011884:Radius / Q000601:surgery / Q000637:transplantation; D011897:Random Allocation; D015996:Survival Rate; D014184:Transplantation, Homologous; D016896:Treatment Outcome