Bone primary sarcomas undergone unplanned intralesional procedures - the possibility of limb salvage and their oncologic results.
BACKGROUND
It is quite rare but some primary sarcomas of the bone can be misdiagnosed as benign and be treated using intralesional procedures. An unplanned surgical excision occurs when tumors are removed without the appropriate preoperative evaluation and consideration for the need to obtain tumor-free margins. Residual tumor tissue as a result of unplanned excision of soft tissue sarcoma is a risk factor for local recurrence.


METHODS
Twenty-five patients, undergone unplanned intralesional procedures of lower extremities, were enrolled in this study. There were 22 (88%) cases of osteosarcomas, 2 (8%) MFH of bone and 1 (4%) adamantinoma. Twenty-two (88%) cases had a limb salvage and among them, 4 (18%) cases had local recurrences. Three cases (12%) had amputation without any local event.


RESULTS
Lung metastasis developed in 6 (24%) cases. The CDF 5 year survival for 22 osteosarcoma cases was 65%(confidence interval: 52-82%).


CONCLUSIONS
Despite the high recurrence rate, the CDF survival of osteosarcoma cases was comparable to the primary one. Limb salvage procedures are worthwhile in cases whose initial radiographic findings simulate benign lesions, showing favorable response to neoadjuvant chemotherapy. The relative contraindication to the limb salvage is cases with a history of a pathologic fracture and extensive operative fixation.
Jeon
Dae-Geun
DG
Department of Orthopaedic Surgery, Korea Cancer Center Hospital, 215-4 Gongneung-Dong, Nowon-Gu, Seoul, Korea. dgjeon@kcch.re.kr
Lee
Soo-Yong
SY
Kim
Jin-Wook
JW
D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000401:mortality / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003475:Curettage; D005260:Female; D006801:Humans; D023821:Limb Salvage; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012516:Osteosarcoma / Q000401:mortality / Q000601:surgery*; D012509:Sarcoma / Q000401:mortality / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome