title: Limb salvage surgery for osteosarcoma: Early results in Indian patients.
abstract: BACKGROUND
  While limb salvage surgery has long been established as the standard of care for osteosarcoma, large studies from Indian centers are few. Given the diverse socio economic milieu of our patients, it becomes significant to determine the feasibility and outcome of management of osteosarcoma in our population. We analyzed the early outcome of limb salvage surgery with multimodality treatment of osteosarcoma of the extremity/girdle bones at a tertiary North Indian Cancer Centre.
  
  
  METHODS
  A total of 51 limb salvage surgeries performed during the months between November 2008 and November 2012 were studied. Neoadjuvant/adjuvant chemotherapy was given by the pediatric/adult medical oncology teams as applicable. The mean followup was 19.45 months (range 2-50 months). The oncological outcome was correlated with age, sex, size of tumor, stage at presentation, site, histological subtype, type of chemotherapy protocol followed and necrosis seen on postoperative examination of resected specimen. The functional outcome of the patients was evaluated using the musculoskeletal tumor society (MSTS) scoring system.
  
  
  RESULTS
  Out of a total of 37 males and 14 females with an average age of 18.8 years, the 3 year overall survival was 66% and 3 year event free survival was 61.8%. In this group of patients with a short followup, a better oncological outcome was associated with good postoperative tumor necrosis, nonchondroblastic histology and age <14 years. The average MSTS score was highest in patients with proximal or distal femur prosthesis and the lowest in patients undergoing a knee arthrodesis.
  
  
  CONCLUSIONS
  The present study shows oncological and functional outcomes of limb salvage combined with chemotherapy in Indian patients with osteosarcoma comparable to those in world literature. Larger studies on Indian population with longer followup are recommended.
authors.affiliation: Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Rohini, New Delhi, India.
authors.forename: Akshay
authors.initials: A
authors.lastname: Tiwari
authors.affiliation: Department of Pediatric Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Rohini, New Delhi, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Jain
authors.affiliation: Department of Plastic and Reconstructive Surgery, Rajiv Gandhi Cancer Institute and Research Center, Rohini, New Delhi, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Rohini, New Delhi, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Pediatric Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Rohini, New Delhi, India.
authors.forename: Gauri
authors.initials: G
authors.lastname: Kapoor
authors.affiliation: Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Rohini, New Delhi, India.
authors.forename: Kapil
authors.initials: K
authors.lastname: Kumar
keywords: Limb salvage surgery; neoadjuvant chemotherapy; oncological outcome; osteosarcoma