title: The prognosis of patients with primary osteosarcoma who have undergone unplanned therapy.
abstract: OBJECTIVE
  For diagnosing osteosarcoma correctly, a combination of clinical, radiological and histological examinations is required. Erroneous treatment may cause local contamination and systemic seeding in patients. The purpose of this study was to compare outcomes of planned and unplanned treatment for osteosarcoma.
  
  
  METHODS
  A retrospective review of patients with high-grade osteosarcoma who received appropriate surgical treatment and chemotherapy (n = 134) and those who were misdiagnosed and received unplanned surgery (n = 16) between July 1995 and February 2005.
  
  
  RESULTS
  Patients who received unplanned treatment were older (mean age: 29.7 vs. 19.7 years; P = 0.003) and had a smaller mean tumor volume (119 vs. 280 ml; P = 0.015). The 5-year survival rate was not statistically different between the groups. Patients who had unplanned treatment had a higher local recurrence rate (43.8 vs. 17.9%; P = 0.024) and a shorter mean time for recurrence (11.9 vs. 20.8 months; P = 0.036). Furthermore, in patients who underwent unplanned treatment, lung metastases occurred earlier (6.1 vs. 16.2 months P = 0.021) and the final limb salvage rate was less (68.7 vs. 87.3%; P < 0.001).
  
  
  CONCLUSIONS
  Unplanned treatment for high-grade osteosarcoma can result in failure of local control and earlier systemic metastases.
authors: Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan.
authors: Ta-I
authors: TI
authors: Wang
authors: Po-Kuei
authors: PK
authors: Wu
authors: Cheng-Feng
authors: CF
authors: Chen
authors: Wei-Ming
authors: WM
authors: Chen
authors: Chueh-Chuan
authors: CC
authors: Yen
authors: Giun-Yi
authors: GY
authors: Hung
authors: Chien-Lin
authors: CL
authors: Liu
authors: Tain-Hsiung
authors: TH
authors: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D002648:Child; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D023821:Limb Salvage; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery / Q000628:therapy; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult