Marginal resection for osteosarcoma with effective neoadjuvant chemotherapy: long-term outcomes
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WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
Marginal resection for osteosarcoma with effective neoadjuvant chemotherapy: long-term outcomes Ming Xu, SongFeng Xu and XiuChun Yu*
Abstract Background: We report the long-term outcomes of patients with osteosarcoma who underwent effective preoperative chemotherapy and subsequently underwent marginal resection. Methods: We reviewed the records of 50 patients with osteosarcoma who underwent marginal resection following effective preoperative chemotherapy; 18 were treated with the MMIA (high-dose methotrexate (HD-MTX), adriamycin (ADR), ifosfamide (IFO)) and cisplatin (DDP), and 32 patients were treated with the DIA (DDP, ADR and IFO). protocol. The functions of the affected limb were evaluated using the revised MSTS93 system. The Kaplan-Meier method was used for survival analysis. Results: After a median follow-up of 5.5 years, the rates were: overall 5-year cumulative survival 61.7%, event-free survival 57.7%, recurrence 8.5%, pulmonary metastases 42.6%, and excellent to good function of the affected limb 57.7%. Conclusions: Our results showed that marginal resection can be performed in patients with osteosarcoma who obtain clinically favorable responses to chemotherapy. Patients had a good clinical course and there was no negative effect on rates of survival or local recurrence. Keywords: Osteosarcoma, Chemotherapy, Adjuvant, Limb salvage, Marginal resection
Background Neoadjuvant chemotherapy and limb preservation is standard treatment for osteosarcoma of the extremities. The classic surgical goal is to create wide surgical margins, but greater excision of structures leads to poorer function. Recently, the need for wide surgical margins has been questioned, with the aim of preserving limb function. Surgical resection should be minimized whenever possible without increasing the risk of local recurrence or jeopardizing the patient’s life. This is the ideal therapeutic strategy for preserving the quality of life of patients with osteosarcoma [1,2]. Since December 1999, we have treated osteosarcoma with marginal resection when a favorable response to chemotherapy is clinically obtained. The purpose of this study was to evaluate the long-term clinical outcomes of marginal resection for osteosarcoma of the extremities.
Methods Patient and chemotherapy protocol
Between December 1999 and October 2008, 50 patients with osteosarcoma (28 male, 22 female; average age of 17 years) underwent marginal resection following effective preoperative chemotherapy. The distal femur was involved in 24 patients, proximal tibia in 19, proximal humerus in 4, proximal fibula in 2, and proximal femur in 1. Of the 50 patients, 49 patients had stage IIB, and 1 had stage IIIB cancer. Chemotherapy drugs comprised high-dose methotrexate (HD-MTX 10 g/m2), adriamycin (ADR 90 mg/m2), ifosfamide (IFO 2.0 g/m2 × 5), and cisplatin (DDP 120 mg/m2), given as one of two chemotherapy protocols: the MMIA protocol (HD-MTX, ADR and IFO) and the DIA protocol (DDP, ADR and IFO). Of the 50 patients,
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