BACKGROUND: Improvements in preoperative staging as well as in chemotherapeutic regimens have made limb-salvage surgery a reliable modality of treatment for high-grade osteosarcomas of the extremities, with local recurrences in most series of less than 10% after this type of surgery. The quality of surgical margins and local response to preoperative chemotherapy are known to be the most significant factors in recurrence [1, 8-10, 12], and complications related to the biopsy procedure may also be a significant factor. The study reported here comprised a histopathological analysis of our recurrent cases as part of an effort to identify the impact of each of the factors cited above. MATERIALS AND METHODS: Five hundred fourteen cases of high-grade, non-multicentric osteosarcoma of the extremities were treated at the Istituto Ortopedico Rizzoli between March 1983 and August 1991. In this study we analyzed 23 cases of local recurrence in patients with classic osteosarcoma who underwent limb-salvage procedures. RESULTS: In 15 cases we found correlation between the site of local recurrence and the site where the margins were less than wide. In five cases the recurrence was secondary to complications of the biopsy procedure (hematoma, delayed healing). In one case we suspect a previously undetected skip lesion. In the remaining two cases no clear explanation was found for the recurrence. There was also a statistically significant difference in the time of appearance of recurrences related to the tumor response to chemotherapy. CONCLUSIONS: For only two cases of recurrence was there no clear explanation. In one we suspect an undetected skip metastasis, and in the other there were certain factors which may have increased its risk of recurrence (non diagnostic trochar biopsy followed by an incisional biopsy, fair tumor necrosis, recurrence in a 'problem' anatomical site, i.e., the popliteal space). In the remaining cases the following factors were found to be directly related to the development of a local recurrence: a) the quality of the surgical margins, b) site of the biopsy as well as complications related to the biopsy procedure, c) local response to preoperative chemotherapy.
BACKGROUND: Improvements in preoperative staging as well as in chemotherapeutic regimens have made limb-salvage surgery a reliable modality of treatment for high-grade osteosarcomas of the extremities, with local recurrences in most series of less than 10% after this type of surgery. The quality of surgical margins and local response to preoperative chemotherapy are known to be the most significant factors in recurrence [1, 8-10, 12], and complications related to the biopsy procedure may also be a significant factor. The study reported here comprised a histopathological analysis of our recurrent cases as part of an effort to identify the impact of each of the factors cited above. MATERIALS AND METHODS: Five hundred fourteen cases of high-grade, non-multicentric osteosarcoma of the extremities were treated at the Istituto Ortopedico Rizzoli between March 1983 and August 1991. In this study we analyzed 23 cases of local recurrence in patients with classic osteosarcoma who underwent limb-salvage procedures. RESULTS: In 15 cases we found correlation between the site of local recurrence and the site where the margins were less than wide. In five cases the recurrence was secondary to complications of the biopsy procedure (hematoma, delayed healing). In one case we suspect a previously undetected skip lesion. In the remaining two cases no clear explanation was found for the recurrence. There was also a statistically significant difference in the time of appearance of recurrences related to the tumor response to chemotherapy. CONCLUSIONS: For only two cases of recurrence was there no clear explanation. In one we suspect an undetected skip metastasis, and in the other there were certain factors which may have increased its risk of recurrence (non diagnostic trochar biopsy followed by an incisional biopsy, fair tumor necrosis, recurrence in a 'problem' anatomical site, i.e., the popliteal space). In the remaining cases the following factors were found to be directly related to the development of a local recurrence: a) the quality of the surgical margins, b) site of the biopsy as well as complications related to the biopsy procedure, c) local response to preoperative chemotherapy.
Authors: Akihiko Takeuchi; Valerae O Lewis; Robert L Satcher; Bryan S Moon; Patrick P Lin Journal: Clin Orthop Relat Res Date: 2014-07-01 Impact factor: 4.176
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Authors: Christopher L Tinkle; Jason Lu; Yuanyuan Han; Yimei Li; Beth M McCarville; Michael D Neel; Michael W Bishop; Matthew J Krasin Journal: Pediatr Blood Cancer Date: 2019-04-22 Impact factor: 3.167
Authors: David Boyce-Fappiano; Ethan P Damron; Ahsan Farooqi; Devarati Mitra; Anthony P Conley; Neeta Somaiah; Dejka M Araujo; J Andrew Livingston; Ravin Ratan; Emily Z Keung; Christina L Roland; B Ashleigh Guadagnolo; Andrew J Bishop Journal: Adv Radiat Oncol Date: 2022-02-05
Authors: Carol D Morris; Lisa A Teot; Mark L Bernstein; Neyssa Marina; Mark D Krailo; Doojduen Villaluna; Katherine A Janeway; Steven G DuBois; Richard G Gorlick; Robert Lor Randall Journal: J Surg Oncol Date: 2016-01-18 Impact factor: 3.454
Authors: Barry P Pereira; Yefang Zhou; Anurag Gupta; David T Leong; Khin Zarchi Aung; Ling Ling; Robert W H Pho; Mario Galindo; Manuel Salto-Tellez; Gary S Stein; Simon M Cool; Andre J van Wijnen; Saminathan S Nathan Journal: J Cell Physiol Date: 2009-12 Impact factor: 6.384