title: Surgical resection of relapse may improve postrelapse survival of patients with localized osteosarcoma.
abstract: BACKGROUND
  Despite neoadjuvant chemotherapy and wide surgical ablation, 15% to 25% of patients with primary osteosarcoma will relapse (local recurrence or metastases). Neither chemotherapy nor radiation therapy alone will render a patient disease-free without concomitant surgical ablation of relapse. We prefer excision of relapse when possible. However, it is unclear whether excision enhances survival.
  
  
  OBJECTIVE
  We therefore determined (1) onset, location, and treatments for relapse; (2) postrelapse disease-free survival of patients who underwent surgical ablation and those who did not; and (3) relapse-free interval between initial diagnosis and first relapse in survivors and in those who died of their disease.
  
  
  METHODS
  We retrospectively reviewed 15 children who initially presented with localized, nonmetastatic extremity osteosarcoma and attained initial complete remission after neoadjuvant chemotherapy, wide local resection, postoperative chemotherapy, and subsequently developed disease relapse. Relapse occurred at a median of 28 months, although late relapse after 5 years occurred in three. We resected the recurrent tumor in nine patients and treated six nonoperatively.
  
  
  RESULTS
  Seven of nine surgically treated patients had a postrelapse disease-free survival ranging from 3 to 14 years and an overall survival ranging from 7 to 16 years. Patients not surgically treated all died within 40 months of their relapse. The median relapse-free interval in patients who survived was longer 34 months (range, 17-152 months) as compared with 17 months (range, 7-40 months) in those who died of their disease.
  
  
  CONCLUSIONS
  Our data confirm the importance of surgery in patients with relapsed osteosarcoma. Disease-free survival in patients with relapsed osteosarcoma is only possible if complete remission is attained. Patients with late relapse may have a better chance of survival.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin NT, Hong Kong SAR, China.
authors.forename: Kwok Chuen
authors.initials: KC
authors.lastname: Wong
authors.forename: Vincent
authors.initials: V
authors.lastname: Lee
authors.forename: Matthew M K
authors.initials: MM
authors.lastname: Shing
authors.forename: Shekhar
authors.initials: S
authors.lastname: Kumta
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002423:Cause of Death; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012516:Osteosarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010027:Osteotomy / Q000009:adverse effects / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome