D Andreou1, S S Bielack2, D Carrle2, M Kevric2, R Kotz3, W Winkelmann4, G Jundt5, M Werner6, S Fehlberg7, L Kager8, T Kühne9, S Lang10, M Dominkus3, G U Exner11, J Hardes4, A Hillmann12, V Ewerbeck13, U Heise14, P Reichardt15, P-U Tunn7. 1. Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Academic Teaching Hospital of the Charité Universitätsmedizin, Berlin. Electronic address: dimosthenis.andreou@helios-kliniken.de. 2. Pediatrics 5-Oncology, Hematology and Immunology, COSS Study Center, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany. 3. Department of Orthopedic Surgery, University Hospital of Vienna, Vienna, Austria. 4. Department of General Orthopedics and Tumororthopedics, University Hospital of Muenster, Muenster, Germany. 5. Department of Pathology, Universitätsspital Basel, Basel, Switzerland. 6. Department of Pathology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Emil von Behring, Berlin, Germany. 7. Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Academic Teaching Hospital of the Charité Universitätsmedizin, Berlin. 8. Department of Hematology/Oncology, St Anna Children's Hospital, Vienna, Austria. 9. Division of Oncology/Hematology, University Children's Hospital, Basel, Switzerland. 10. Department of Pathology, University Hospital of Vienna, Vienna, Austria. 11. Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland. 12. Department of Orthopedics, Klinikum Ingolstadt, Ingolstadt. 13. Department of Orthopedics and Traumatology, University Hospital of Heidelberg, Heidelberg. 14. Department of Orthopedics, Albertinen Hospital, Hamburg. 15. Department of Hematology, Oncology and Palliative Care, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Bad Saarow, Academic Teaching Hospital of the Charité Universitätsmedizin, Bad Saarow, Germany.
Abstract
BACKGROUND: Local recurrence (LR) in osteosarcoma is associated with very poor prognosis. We sought to evaluate which factors correlate with LR in patients who achieved complete surgical remission with adequate margins. PATIENTS AND METHODS: We analyzed 1355 patients with previously untreated high-grade central osteosarcoma of the extremities, the shoulder and the pelvis registered in neoadjuvant Cooperative Osteosarcoma Study Group trials between 1986 and 2005. Seventy-six patients developed LR. RESULTS: Median follow-up was 5.56 years. No participation in a study, pelvic tumor site, limb-sparing surgery, soft tissue infiltration beyond the periosteum, poor response to neoadjuvant chemotherapy, failure to complete the planned chemotherapy protocol and biopsy at a center other than the one performing the tumor resection were significantly associated with a higher LR rate. No differences were found for varying surgical margin widths. Surgical treatment at centers with small patient volume and additional surgery in the primary tumor area, other than biopsy and tumor resection, were significantly associated with a higher rate of ablative surgery. CONCLUSIONS: Patient enrollment in clinical trials and performing the biopsy at experienced institutions capable of undertaking the tumor resection without compromising the oncological and functional outcome should be pursued in the future.
BACKGROUND: Local recurrence (LR) in osteosarcoma is associated with very poor prognosis. We sought to evaluate which factors correlate with LR in patients who achieved complete surgical remission with adequate margins. PATIENTS AND METHODS: We analyzed 1355 patients with previously untreated high-grade central osteosarcoma of the extremities, the shoulder and the pelvis registered in neoadjuvant Cooperative Osteosarcoma Study Group trials between 1986 and 2005. Seventy-six patients developed LR. RESULTS: Median follow-up was 5.56 years. No participation in a study, pelvic tumor site, limb-sparing surgery, soft tissue infiltration beyond the periosteum, poor response to neoadjuvant chemotherapy, failure to complete the planned chemotherapy protocol and biopsy at a center other than the one performing the tumor resection were significantly associated with a higher LR rate. No differences were found for varying surgical margin widths. Surgical treatment at centers with small patient volume and additional surgery in the primary tumor area, other than biopsy and tumor resection, were significantly associated with a higher rate of ablative surgery. CONCLUSIONS:Patient enrollment in clinical trials and performing the biopsy at experienced institutions capable of undertaking the tumor resection without compromising the oncological and functional outcome should be pursued in the future.
Authors: J S Whelan; R C Jinks; A McTiernan; M R Sydes; J M Hook; L Trani; B Uscinska; V Bramwell; I J Lewis; M A Nooij; M van Glabbeke; R J Grimer; P C W Hogendoorn; A H M Taminiau; H Gelderblom Journal: Ann Oncol Date: 2011-10-19 Impact factor: 32.976