Long-term results of combined therapy for primary osteosarcoma in extremities of 189 cases

Abstract

To evaluate the survival rates and complications of combined therapy for primary osteosarcoma of the extremities between 1992 and 2001. From 1992 to 2002, 189 patients with non-metastatic osteosarcoma were treated. Their average age at diagnosis was 18 years old (ranging from 4 to 39). Tumors were located at distal femurs in 86 patients, proximal femurs in 4, proximal tibia in 52, proximal humors in 19 and other locations in 28. Combined therapy (resection of tumor with chemotherapy) was given 116 patients and non-combined therapy (tumor resection only and unfinished chemotherapy) to 73. In combined therapy group, 90 patients underwent limb salvage surgery, and 26 patients received amputations. In non-combined therapy group, 42 patients underwent limb salvage surgery and 31 patients received amputations. The 5-year-survival rates were 78.5% in the combined therapy group and 35.1% in the non-combined therapy group. Local recurrence rate was 16.6% (15 cases) in limb salvage surgery with combined therapy group (90 cases) and 38.1% (16 cases) in limb salvage surgery with non-combined therapy group (42 cases) (P < 0.007). Metastasis rate was 28.4% (33 cases) in the combined therapy group (116 cases) and 65.7% (48 cases) in the non-combined therapy group (73 cases) (P < 0.000). Functional evaluation showed that the patients who underwent salvage surgery had higher functional scores than those who had an amputation. According to MSTS scoring system (1993), 56 patients (excision alcohol replacement 36 cases, allograft 10 cases and prosthesis 10 cases) were evaluated functional scores. The average scores reached same level (P > 0.5). (1) In this study, the 5-year-survival rate in the combined therapy is improved. The treatment for the patients with metastasis in lung is very difficult for improvement of the 5-year-survival rate. (2) The local recurrence is related the surgical margin. The adequate surgical margin is very important for the limb salvage. (3) The combined therapy is very essential for improving survival rate.