Abstract

Osteosarcoma is a primary malignant bone tumor usually arising at the metaphysis of long bones, particularly around the knee. The physis has been regarded as a barrier capable of blocking tumor extension, thus allowing it to preserve their epiphysis and therefore improve functional results. With the objective of clarifying how effective the physis is as a barrier to tumor spread, a large series of skeletally immature patients with osteosarcoma were reviewed. From 452 metaphyseal osteosarcomas a selection of 282 cases in which the tumor was close or crossing the physis were carried out. This sub-sample was split into two groups according to the surgical treatment (epiphyseal preservation or not). The specimens obtained by resection were studied, and the physeal and metaphyseal areas were studied by multiple sections. Immunostaining against VEGF of physis was obtained in selected cases. In about half of the patients affected by metaphyseal malignant bone tumors, the growth plate and epiphysis were not compromised by the tumor. Three sequential invasive growth patterns of an osteosarcoma in its relationship with the physis could be distinguished. An intense angiogenesis and osteoclastic reaction could be observed in the growth plate in the free zone between the tumor and the physis. The local recurrence incidence was lower in the epiphyseal preservation treated patients than it was in the conventional treatment (8% vs. 12%). Most local recurrences appeared in the first 2 years. The overall survival of patients treated with epiphyseal preservation was better than that of the patients treated without preserving the epiphysis (73% vs. 59%; p = 0.03) at a mean follow-up of 18 years. We have described an angiogenic and osteoclastic reaction in the base of the growth plate in the proximity of the advance front of the tumor, which could facilitate the osteosarcoma invasion. It is also shown that the preoperative imaging method for examination is a valid approach for the decision to carry out epiphyseal preservation. Finally, we concluded that epiphyseal preservation combined with protective chemotherapy is an excellent clinical approach for selected patients with metaphyseal osteosarcoma.

Highlights

  • IntroductionOsteosarcoma is a primary malignant bone tumor usually located in the metaphysis

  • This article is an open access articleOsteosarcoma is a primary malignant bone tumor usually located in the metaphysis.It tends to infiltrate adjacent bone as well as soft tissue

  • The physis has been regarded as a barrier capable of blocking tumor extension [1,2], and this idea has been strengthened by experimental studies carried out in vitro, which suggests that the barrier effect is due to certain proteins in the physis that are inhibitory of angiogenesis [3,4,5,6,7]

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Summary

Introduction

Osteosarcoma is a primary malignant bone tumor usually located in the metaphysis. It tends to infiltrate adjacent bone as well as soft tissue. Effect is due to certain proteins in the physis that are inhibitory of angiogenesis [3,4,5,6,7] Several growth factors, such as insulin-like growth factors or fibroblast growth factors as well of 11 as bone morphogenetic proteins and parathormones, have been related to the growing of the epiphyseal plate [8,9]. Knowledge of whether growth plate has been a barrier a particular case is growth crucial to choosing theas growththe factors, such as insulin-like growthinfactors or fibroblast factors as well optimal surgical procedure for that bone morphogenetic proteins and case

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