title: Osteosarcoma of the spine: dismal past, any hope for the future?
abstract: OBJECTIVE
  The purpose of this study was to analyse all cases of spinal osteosarcoma (OS) treated in a regional bone tumour unit over the last 27 years. We were primarily interested in overall survival following tumour surgery, and if there is a difference in the survival of patients undergoing en bloc resection versus non-en bloc surgery.
  
  
  METHODS
  Prospectively maintained tumour databases were searched in a regional bone tumour unit. All cases of surgically managed spinal OS were extracted and inpatient notes, imaging (including staging), histological margin status, and outcomes (neurological deficit and survival curves) were reviewed.
  
  
  RESULTS
  Twenty-six patients were identified between 1985 and 2012. The median age was 26.5 years (range 6-78 y). Overall Kaplan-Meier survival was 69.5% (95% CI: 46.3-84.2%) and 10.8% (95% CI: 1.8-29.0%) at 1 and 5 years, respectively. There appears to be improved survival associated with primary spinal OS compared to that of metastatic disease, but this does not reach statistical significance (p = 0.29, Cox proportional hazards analysis). En bloc resection results in a significantly improved survival time compared to non-en bloc (biopsy and debulking): 44.1% alive at 2 years compared to 9.4%, respectively, p = 0.009.
  
  
  CONCLUSIONS
  En bloc resection for primary spinal OS is associated with improved survival; there have been major changes in both surgical treatment and chemo/radiotherapy regimens over the period studied, potentially confounding the interpretation.
authors.affiliation: Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square , London , UK.
authors.forename: Robin
authors.initials: R
authors.lastname: Bhatia
authors.forename: Verona
authors.initials: V
authors.lastname: Beckles
authors.forename: Zoe
authors.initials: Z
authors.lastname: Fox
authors.forename: Roberto
authors.initials: R
authors.lastname: Tirabosco
authors.forename: Kia
authors.initials: K
authors.lastname: Rezajooi
authors.forename: Adrian T H
authors.initials: AT
authors.lastname: Casey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D012516:Osteosarcoma / Q000401:mortality* / Q000601:surgery*; D013125:Spinal Neoplasms / Q000401:mortality* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: chemotherapy; operative; spine; tumour