title: Assessment of extent of surgical resection of primary high-grade osteosarcoma by treating institutions: A report from the Children's Oncology Group.
abstract: BACKGROUND
  Complete surgical resection of primary tumors is critical for long-term control of high-grade osteosarcoma. Uniform assessment of the extent of surgical resection is important in clinical trials, though the accuracy of this reporting has been poorly studied.
  
  
  METHODS
  We conducted a retrospective cohort study of patients 5-40 years of age with newly diagnosed high-grade resectable osteosarcoma treated as part of the AOST0331 clinical trial at Children's Oncology Group institutions. The extent of surgical resection of the primary tumor was graded as wide or radical by the treating institution. Central assessment of the extent of resection by two orthopedic oncologists was compared with institutional assessment by reviewing pathology and operative reports.
  
  
  RESULTS
  We included 956 patients who had data available for central review. The extent of resection reported by treating institutions was 536/956 (56%) radical and 420/956 (44%) wide. The extent of resection assessed by central review was 162/956 (17%) radical and 794/956 (83%) wide. The overall discordance rate for the cohort was 43%.
  
  
  CONCLUSIONS
  Institutional reports of radical resection in high-grade osteosarcoma significantly over-estimate the proportion of patients undergoing radical resection. This highlights the need for centralized review and improved accuracy of reporting of the extent of resection. J. Surg. Oncol. 2016;113:351-354. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Departments of Orthopaedic Surgery and Oncology, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Carol D
authors.initials: CD
authors.lastname: Morris
authors.affiliation: Department of Pathology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Teot
authors.affiliation: Department of Pediatrics, IWK Health Centre, Nova Scotia, Canada.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Bernstein
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Neyssa
authors.initials: N
authors.lastname: Marina
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Krailo
authors.affiliation: Statistics and Data Center, Children's Oncology Group, Monrovia, California.
authors.forename: Doojduen
authors.initials: D
authors.lastname: Villaluna
authors.affiliation: Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Janeway
authors.affiliation: Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, California.
authors.forename: Steven G
authors.initials: SG
authors.lastname: DuBois
authors.affiliation: Department of Pediatrics, The Children's Hospital of Montefiore, Bronx, New York.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Gorlick
authors.affiliation: Department of Orthopaedics, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Robert Lor
authors.initials: RL
authors.lastname: Randall
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D060787:Neoplasm Grading; D012516:Osteosarcoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate
keywords: cooperative group trial; osteosarcoma; surgical margins