title: Management of local recurrence of pediatric osteosarcoma following limb-sparing surgery.
abstract: BACKGROUND
  The optimal management of locally recurrent pediatric osteosarcoma is not established, especially after prior limb-sparing surgery. We describe our experience in the management of these patients and identify prognostic indicators of post-recurrence survival.
  
  
  METHODS
  We conducted a retrospective, single-institution review of patients with locally recurrent osteosarcoma after limb-salvage surgery who were treated between October 1989 and January 2012. The management of each recurrence was evaluated, and patient, disease, and treatment factors were correlated with post-recurrence survival (PRS).
  
  
  RESULTS
  Of 200 patients who underwent limb-sparing procedures, 18 (9 %) had biopsy-proven local recurrence. Recurrences occurred in soft tissue in 15 patients (83.3 %). Six patients (33.3 %) were amenable to repeat limb-sparing surgery. Median time to local recurrence was 1.4 (range 0.6-10.4) years. Median PRS was 11.8 months (range 3.7 months-12.1 years). Post-recurrence survival was significantly associated with the length of resection margins and was longer when recurrent tumors were resected with margins of ≥1 cm, compared with subcentimeter or positive margins (P = 0.03). Median PRS was longer in patients who underwent amputations (2.44 years) than those who underwent repeat limb-sparing surgery (0.86 years), and in patients who had distant metastases resected (2.7 years) than those who did not (0.85 years); however, differences were not significant.
  
  
  CONCLUSIONS
  Local management of recurrent osteosarcoma in a previously reconstructed limb is highly individualized. A sufficiently wide resection is important for local control of recurrences, independent of the type of surgery. Maintaining control of distant metastases may also contribute to improved survival.
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA, amos.loh@stjude.org.
authors.forename: Amos H P
authors.initials: AH
authors.lastname: Loh
authors.forename: Fariba
authors.initials: F
authors.lastname: Navid
authors.forename: Chong
authors.initials: C
authors.lastname: Wang
authors.forename: Armita
authors.initials: A
authors.lastname: Bahrami
authors.forename: Jianrong
authors.initials: J
authors.lastname: Wu
authors.forename: Michael D
authors.initials: MD
authors.lastname: Neel
authors.forename: Bhaskar N
authors.initials: BN
authors.lastname: Rao
mesh_terms: D000293:Adolescent; D000671:Amputation, Surgical; D001859:Bone Neoplasms / Q000473:pathology / Q000601:surgery*; D002648:Child; D005260:Female; D005269:Femur; D006801:Humans; D006811:Humerus; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D012516:Osteosarcoma / Q000556:secondary / Q000601:surgery*; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000556:secondary / Q000601:surgery*; D015996:Survival Rate; D013977:Tibia; D055815:Young Adult