Whether neoadjuvant chemotherapy safely allows close margins in osteosarcoma patients is still unknown. This study investigates the impact of close margins on local recurrence (LR) and overall survival (OS) for osteosarcoma patients treated with neoadjuvant chemotherapy.
We retrospectively reviewed 47 cases of conventional osteosarcoma who were treated at our institution. Patient and treatment factors such as age, gender, MSTS stage, tumour site, surgery type, pathological type, tumour size, surgical margin, tumour necrosis rate, chemotherapy regimens and cycles were recorded. A close margin was defined as tumour present less than 5 mm from the closest resection margin. The average followup was 87.6 months (range, 25–135 months).
Twenty-five patients were alive, 22 patients had died, and eight had LR. Twenty-eight patients had wide margins, seven had positive margins and 12 had close margins. Positive margins had a greater risk of LR (57.1%) than wide margins and close margins. There was no difference in LR (8.3% vs 10.7%) between close margins and wide margins. Margin status was not correlated with OS.
Compared with wide margins, close margins did not lead to increased local recurrence in our study group. Whether close margins, as defined in our study, are just as acceptable as wide margins in terms of patient outcomes for osteosarcoma patients with neoadjuvant chemotherapy needs to be further confirmed in the future.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Carrle D, Bielack SS (2006) Current strategies of chemotherapy in osteosarcoma. Int Orthop 30:445–451
Funovics PT, Edelhauser G, Funovics MA, Laux C, Berzaczy D, Kubista B, Kotz RI, Dominkus M (2011) Pre-operative serum C-reactive protein as independent prognostic factor for survival but not infection in patients with high-grade osteosarcoma. Int Orthop Jan 21 [Epub ahead of print] doi:10.1007/s00264-011-1208-8
Bacci G, Longhi A, Versari M, Mercuri M, Briccoli A, Picci P (2006) Prognostic factors for osteosarcoma of the extremity treated with neoadjuvant chemotherapy. Cancer 106:1154–1161
Bacci G, Forni C, Longhi A, Ferrari S, Mercuri M, Bertoni F, Serra M, Briccoli A, Balladelli A, Picci P (2007) Local recurrence and local control of non-metastatic osteosarcoma of the extremities: a 27-year experience in a single institution. J Surg Oncol 96:118–123
Bacci G, Ferrari S, Longhi A, Perin S, Forni C, Fabbri N, Salduca N, Versari M, Smith KVJ (2001) Pattern of relapse in patients with osteosarcoma of the extremities treated with neoadjuvant chemotherapy. Eur J Cancer 37:32–38
Bacci G, Briccoli A, Ferrari S, Longhi A, Mercuri M, Capanna R, Donati D, Lari S, Forni C, DePaolis M (2001) Neoadjuvant chemotherapy for osteosarcoma of the extremity: long-term results of the Rizzoli’s 4th protocol. Eur J Cancer 37:2030–2039
Picci P, Sangiorgi L, Rougraff BT, Neff JR, Casadei R, Campanacci M (1994) Relationship of chemotherapy-induced necrosis and surgical margins to local recurrence in osteosarcoma. J Clin Oncol 12:2699–2705
Grimer RJ, Taminiau AM, Cannon SR (2002) Surgical outcomes in osteosarcoma. J Bone Joint Surg Br 84:395–400
Ferrari S, Bacci G, Picci P, Mercuri M, Briccoli A, Pinto D, Gasbarrini A, Tienghi A, Brach del Prever A (1997) Long-term follow-up and post-relapse survival in patients with non-metastatic osteosarcoma of the extremity treated with neoadjuvant chemotherapy. Ann Oncol 8:765–771
Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 153:106–120
Hayashi K, Tsuchiya H, Yamamoto N, Takeuchi A, Tomita K (2008) Functional outcome in patients with osteosarcoma around the knee joint treated by minimised surgery. Int Orthop 32(1):63–68
Kawaguchi N, Ahmed AR, Matsumoto S, Manabe J, Matsushita Y (2004) The concept of curative margin in surgery for bone and soft tissue sarcoma. Clin Orthop Relat Res 419:165–172
Bispo Júnior RZ, de Camargo OP (2009) Prognostic factors in the survival of patients diagnosed with primary non-metastatic osteosarcoma with a poor response to neoadjuvant chemotherapy. Clinics 64:1177–1186
Bacci G, Mercuri M, Longhi A, Ferrari S, Bertoni F, Versari M, Picci P (2005) Grade of chemotherapy-induced necrosis as a predictor of local and systemic control in 881 patients with non-metastatic osteosarcoma of the extremities treated with neoadjuvant chemotherapy in a single institution. Eur J Cancer 41:2079–2085
de Bree R, van der Valk P, Kuik DJ, van Diest PJ, Doornaert P, Buter J, Eerenstein SE, Langendijk JA, van der Waal I, Leemans CR (2006) Prognostic factors in adult soft tissue sarcomas of the head and neck: a single-centre experience. Oral Oncol 42:703–709
Ham SJ, Kroon HM, Schraffordt Koops H, Hoekstra HJ (2000) Osteosarcoma of the pelvis-oncological results of 40 patients registered by the Netherlands Committee on Bone Tumours. Eur J Surg Oncol 26:53–60
Fuchs B, Hoekzema N, Larson DR, Inwards CY, Sim FH (2009) Osteosarcoma of the pelvis: outcome analysis of surgical treatment. Clin Orthop Relat Res 467:510–518
Ozaki T, Flege S, Kevric M, Lindner N, Maas R, Delling G, Schwarz R, von Hochstetter AR, Salzer-Kuntschik M, Berdel WE, Jürgens H, Exner GU, Reichardt P, Mayer-Steinacker R, Ewerbeck V, Kotz R, Winkelmann W, Bielack SS (2003) Osteosarcoma of the pelvis: experience of the Cooperative Osteosarcoma Study Group. J Clin Oncol 21:334–341
Shin KH, Moon SH, Suh JS, Yang WI (2000) Tumor volume change as a predictor of chemotherapeutic response in osteosarcoma. Clin Orthop Relat Res 376:200–208
Bielack SS, Kempf-Bielack B, Delling G, Exner GU, Flege S, Helmke K, Kotz R, Salzer-Kuntschik M, Werner M, Winkelmann W, Zoubek A, Jürgens H, Winkler K (2002) Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol 20:776–790
Ford S, Saithna A, Grimer RJ, Picci P (2004) Comparison of the outcome of conventional osteosarcoma at two specialist international orthopaedic oncology centres. Sarcoma 8:13–18
Kubista B, Klinglmueller F, Bilban M, Pfeiffer M, Lass R, Giurea A, Funovics PT, Toma C, Dominkus M, Kotz R, Thalhammer T, Trieb K, Zettl T, Singer CF (2010) Microarray analysis identifies distinct gene expression profiles associated with histological subtype in human osteosarcoma. Int Orthop Mar 26 [Epub ahead of print] doi:10.1007/s00264-010-0996-6
Docquier PL, Paul L, Cartiaux O, Lecouvet F, Dufrane D, Delloye C, Galant C (2010) Formalin fixation could interfere with the clinical assessment of the tumor-free margin in tumor surgery: magnetic resonance imaging-based study. Oncology 78(2):115–124
We thank Linda D. Pickron for assistance with collecting all the medical charts for this research.
Xin Li received funding in the form of a visiting scholarship from the China Scholarship Council; Vincent M. Moretti and Adedayo O. Ashana received funding in the form of a research fellowship from Stryker Orthopaedics, Mahwah, NJ. One of the authors (RDL) is a consultant for Stryker Orthopaedics, Mahwah, NJ.
This work was performed in the Department of Orthopaedic Surgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA.
Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigators were conducted in conformity with ethical principles for research. This study was approved by the Institutional Review Board.
Rights and permissions
About this article
Cite this article
Li, X., Moretti, V.M., Ashana, A.O. et al. Impact of close surgical margin on local recurrence and survival in osteosarcoma. International Orthopaedics (SICOT) 36, 131–137 (2012). https://doi.org/10.1007/s00264-011-1230-x
- Overall Survival
- Local Recurrence
- Preoperative Chemotherapy
- Positive Margin