Marginal resection for osteosarcoma: Long-term outcomes.

Abstract

e20505 Background: When a favorable response to chemotherapy is clinically obtained, we usually perform intentional marginal resection, which preserves the surrounding areas that are normally resected, such as ligament, nerves, blood vessels, and epiphysis region. We report on the long-term outcomes of osteosarcoma patients who underwent the combination therapy and subsequently underwent intentional marginal resection. Methods: The subjects were 43 patients with osteosarcoma. The mean age was 15 years and the mean follow-up period was 101 months. Tumors were Enneking’s surgical stage IIB in 36 patients and IIIB in 7 patients. The patients received preoperatively 3-5 courses of intraarterial fusion of caffeine combined with CDDP and ADM. The effectiveness of chemotherapy was evaluated using plain x-ray, angiography, MRI, and thallium scintigraphy. If the results of two or more imaging examinations showed effectiveness of the treatment, the patient was considered to have a complete response or partial response. Results: The treatment was effective in 14 patients (Grade III) and 29 patients (Grade IV) by histological evaluation (Rosen & Huvos) that correlated with the results of imaging evaluation. Limb function was evaluated according to ISOLS scoring system, excellent is 32 patients (74.4%), good in 7 patients (16.3%), fair in 3 patients (7.0%), and poor in 1 patient (2.3%). Local recurrence was observed in only 2 patients (4.7%). For stage IIB patients, both 5- and 10-year cumulative survival rates were 93.8%. The outcome (IIB + IIIB) was CDF in 26 patients, NED in 8 patients, AWD in 1 patient, and DOD in 7 patients. Conclusions: It is important to minimize surgical margin and to preserve healthy tissue and important structures for improving the function of the affected limb and providing optimal quality of life for the osteosarcoma patients. In the present study, intentional marginal resection was performed in osteosarcoma patients who were clinically obtained favorable responses to a combination of chemotherapy and caffeine administration. They had a good clinical course and there was no negative effect on the survival rate or local recurrence rate.