title: The Surgical Treatment and Outcome of Nonmetastatic Extremity Osteosarcoma with Pathological Fractures.
abstract: BACKGROUND
  Recent studies have suggested that the presence of a pathological fracture does not impact on oncologic outcomes and the feasibility of limb salvage surgery (LSS) in appropriately selected patients when combined with neoadjuvant chemotherapy. These have largely been single institutional studies with limited numbers. The Eastern Asian Musculoskeletal Oncology Group reviewed the data from three large volume Asian orthopedic oncology centers to determine whether the presence of a pathologic fracture affected outcomes in osteosarcoma patients.
  
  
  METHODS
  A retrospective review of the data was conducted. Ninety-five cases of nonmetastatic extremity osteosarcoma with a pathological fracture and 887 cases without fracture treated during the same period were compared.
  
  
  RESULTS
  In the fracture group, the LSS rate was 62.1%, and the rate of amputation was 37.9%. In the nonfracture group, the LSS rate was 74.7%, and the amputation was 25.3%. In patients with a pathologic fracture, the rate of local recurrence for LSS and amputation groups was 8.5% and 2.8%, respectively. In this group, the 5-year survival in the LSS group was 66% as against. 46.8% in the amputation group.
  
  
  CONCLUSIONS
  Our study suggests that surgically treated patients with pathologic fractures in osteosarcoma have adequate local control and do not have a poorer outcome compared to patients without a fracture. Though osteosarcoma with a pathologic fracture is not a contraindication for limb salvage, appropriate case selection is important when deciding local control options to ensure adequate oncologic clearance.
authors.forename: Zhi-Ping
authors.initials: ZP
authors.lastname: Deng
authors.forename: Yi
authors.initials: Y
authors.lastname: Ding
authors.forename: Ajay
authors.initials: A
authors.lastname: Puri
authors.forename: Edward H M
authors.initials: EH
authors.lastname: Wang
authors.forename: Ashish
authors.initials: A
authors.lastname: Gulia
authors.forename: Claire
authors.initials: C
authors.lastname: Durban
authors.affiliation: Department of Orthopaedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking University, Beijing 100035, China.
authors.forename: Xiao-Hui
authors.initials: XH
authors.lastname: Niu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000150:complications / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005121:Extremities / Q000473:pathology / Q000601:surgery; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology / Q000601:surgery; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000601:surgery; D012516:Osteosarcoma / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult