title: Osteosarcomas in the upper distal extremities: are their oncological outcomes similar to other sites?
abstract: OBJECTIVE
  To investigate whether the oncological outcomes of patients with osteosarcomas in the upper distal extremity are similar to other sites and assess if limb-salvage surgery is safe in this location.
  
  
  METHODS
  The centre database was used to identify all patients with osteosarcomas in the lower humerus and distally between 1985 and 2012. Patient, tumor, treatment and outcome data was collected.
  
  
  RESULTS
  Twenty-six patients were included in this study. There were 9 males and 17 females with a mean age of 33 years (9-90). Seventeen osteosarcomas were located in the forearm bones (65%), six in the distal humerus (23%), and three (12%) in the hand. The three most common sub-diagnoses were parosteal 7/21 (33%), fibroblastic 4/21 (19%) and osteoblastic osteosarcomas 3/21 (14%). 2 patients (8%) had Paget's disease and 19 patients (73%) had high-grade tumors. Local excision was carried out in 12 patients (48%), 4 patients underwent endoprosthetic replacement (16%) and 9 underwent amputation (36%). The overall risk of local recurrence was 4% in our series. The five-year overall survival rate was 67%, with low tumor grade and parosteal type of osteosarcoma being positive predictors of survival.
  
  
  CONCLUSIONS
  This series has shown that patients with high-grade osteosarcomas of the upper distal extremities have a higher amputation risk than other limb sites but have favorable outcomes with limb-salvage surgery, comparable to other anatomical sites. Parosteal osteosarcomas in particular have a good prognosis.
authors.affiliation: Oncology Department, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK. Electronic address: anup925@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Pradhan
authors.affiliation: Oncology Department, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK.
authors.forename: K I A
authors.initials: KI
authors.lastname: Reddy
authors.affiliation: Oncology Department, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Grimer
authors.affiliation: Oncology Department, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK.
authors.forename: A
authors.initials: A
authors.lastname: Abudu
authors.affiliation: Oncology Department, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: Tillman
authors.affiliation: Oncology Department, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK.
authors.forename: S R
authors.initials: SR
authors.lastname: Carter
authors.affiliation: Oncology Department, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK.
authors.forename: L
authors.initials: L
authors.lastname: Jeys
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000473:pathology / Q000628:therapy*; D002648:Child; D005260:Female; D050276:Hand Bones / Q000473:pathology / Q000601:surgery; D006801:Humans; D006811:Humerus / Q000473:pathology / Q000601:surgery; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D012516:Osteosarcoma / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D019919:Prosthesis Implantation / Q000379:methods; D011884:Radius / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014457:Ulna / Q000473:pathology / Q000601:surgery; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Local recurrence; Osteosarcoma; Survival; Upper distal extremity