title: Impact of close surgical margin on local recurrence and survival in osteosarcoma.
abstract: OBJECTIVE
  Whether neoadjuvant chemotherapy safely allows close margins in osteosarcoma patients is still unknown. This study investigates the impact of close margins on local recurrence (LR) and overall survival (OS) for osteosarcoma patients treated with neoadjuvant chemotherapy.
  
  
  METHODS
  We retrospectively reviewed 47 cases of conventional osteosarcoma who were treated at our institution. Patient and treatment factors such as age, gender, MSTS stage, tumour site, surgery type, pathological type, tumour size, surgical margin, tumour necrosis rate, chemotherapy regimens and cycles were recorded. A close margin was defined as tumour present less than 5 mm from the closest resection margin. The average followup was 87.6 months (range, 25-135 months).
  
  
  RESULTS
  Twenty-five patients were alive, 22 patients had died, and eight had LR. Twenty-eight patients had wide margins, seven had positive margins and 12 had close margins. Positive margins had a greater risk of LR (57.1%) than wide margins and close margins. There was no difference in LR (8.3% vs 10.7%) between close margins and wide margins. Margin status was not correlated with OS.
  
  
  CONCLUSIONS
  Compared with wide margins, close margins did not lead to increased local recurrence in our study group. Whether close margins, as defined in our study, are just as acceptable as wide margins in terms of patient outcomes for osteosarcoma patients with neoadjuvant chemotherapy needs to be further confirmed in the future.
authors.affiliation: Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, 107 Wen Hua Xi Road, Jinan, Shandong, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Li
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Moretti
authors.forename: Adedayo O
authors.initials: AO
authors.lastname: Ashana
authors.forename: Richard D
authors.initials: RD
authors.lastname: Lackman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local; D012516:Osteosarcoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult