Marginal resection for osteosarcoma with effective preoperative chemotherapy.
OBJECTIVE
To present the clinical results of marginal resection with effective preoperative chemotherapy for treatment of osteosarcoma.


METHODS
Thirty-eight patients (20 male and 18 female, average age 17 years), underwent marginal resection after confirmation of effective preoperative chemotherapy between 1999 and 2008 and the results were analyzed retrospectively. The distal femur was involved in 22 cases, proximal tibia in 11, proximal humerus in 4, and proximal fibula in 1. Thirty-seven patients were stage IIB and one IIIB. Twenty-nine patients were treated with the DIA, and 9 with the MMIA protocol. Twenty-one patients underwent tumor resection and bone allograft transplantation. The epiphysis was preserved in 9 patients, and not in the other 12. Eleven patients underwent tumor resection and prosthetic replacement, and 4 tumor resection with autograft implantation. One patient underwent tumor resection and allograft with preservation of the epiphysis; another underwent marginal tumor resection only.


RESULTS
All patients received effective preoperative chemotherapy. At a median follow-up of 52 months, local recurrence had developed in one patient (2.6% local recurrence rate). Pulmonary metastases developed in 9 patients (23.7%). Five patients died of metastases, one died of intracranial hemorrhage due to thrombocytopenia caused by postoperative chemotherapy. The overall 2-year survival rate was 87.3%, and event-free survival rate 75.5%. The overall 5-year survival rate was 74.7%, and event-free survival rate 60.8%. Excellent to good function of affected limbs was achieved in 60.5%.


CONCLUSIONS
With careful preoperative evaluation and effective preoperative chemotherapy marginal resection of osteosarcoma can produce good results. Marginal resection of osteosarcoma should be performed by an experienced surgeon who is familiar with the limb salvage rules for osteosarcoma.
Department of Orthopaedics, The General Hospital of Jinan Military Region, Jinan, China. yxch36@yahoo.com.cn
Xiu-chun
XC
Yu
Ming
M
Xu
Ruo-xian
RX
Song
Song-feng
SF
Xu
D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D002681:China / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D005269:Femur; D005360:Fibula; D005500:Follow-Up Studies; D006801:Humans; D006811:Humerus; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D012516:Osteosarcoma / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013977:Tibia; D013997:Time Factors
D000970:Antineoplastic Agents