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The effect of preoperative radiotherapy on local control and prognosis in high-grade non-metastatic intramedullary osteosarcoma of the extremities

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

This study aimed to analyse the effect of preoperative radiotherapy on survival, recurrence and necrosis rates in osteosarcoma patients treated with neoadjuvant chemotherapy and limb-salvage surgery.

Materials and methods

Osteosarcoma patients who referred to our clinic from 1998 to 2015 were investigated retrospectively. 141 patients with non-metastatic osteosarcoma of the limb who received neoadjuvant chemotherapy and underwent limb-sparing surgery with or without preoperative radiotherapy were included in the study. 73 patients had neoadjuvant chemotherapy only (CT group), while 68 patients had additional preoperative radiotherapy (CT + RT group). 5-year survival, disease-free survival, limb survival, local recurrence, metastasis, complication and necrosis rates were compared between the two groups.

Results

Overall 5-year survival, 5-year disease-free survival, 5-year limb survival rates were 68.5, 64.3, 65.7 for CT group and 72.1, 67.6, 64.7 for CT + RT group, respectively. Preoperative radiotherapy gave similar survival and disease-free survival rates. Limb survival, recurrence and metastasis rates were similar between the groups. The necrosis rate of the lesions was significantly higher in the CT + RT group compared to the CT group.

Conclusion

Preoperative radiotherapy can provide a higher necrosis rate and may allow the resection of unresectable lesions in the treatment of osteosarcoma. CT + RT provided similar 5-year survival despite the larger tumour size compared to CT group. Due to the higher wound complication rate (8.2% in CT, 23.5% in CT + RT group, p = 0.01), CT + RT should be restricted to the lesions with large size or close proximity to neurovascular structures.

Level of evidence

Level III; Therapeutic, Retrospective comparative study.

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Funding

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Author information

Author notes

  1. Murat Hiz and Bedri Karaismailoglu are co-first authors.

Authors and Affiliations

  1. Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Istanbul, 34093, Turkey

    Murat Hız, Bedri Karaismailoglu, Suat Ulutas & Vedat Burkay Camurdan

  2. Nisantasi Ortopedi Merkezi, Istanbul, Turkey

    Baris Gorgun

  3. Cerrahpasa Medical Faculty, Department of Radiation Oncology, Istanbul University-Cerrahpasa, Istanbul, Turkey

    Fazilet Oner Dincbas

Authors
  1. Murat Hız
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  2. Bedri Karaismailoglu
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  3. Suat Ulutas
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  4. Vedat Burkay Camurdan
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  5. Baris Gorgun
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  6. Fazilet Oner Dincbas
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Contributions

All authors contributed to the study conception and design. MH was the senior surgeon who performed all surgeries, supervised the study and revised the manuscript critically for important intellectual content. BK prepared the manuscript, collected the data and made the analyses. SU, VBC, and BG helped the data collection and analysis. FOD planned the radiotherapy of the patients and contributed to the content of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Bedri Karaismailoglu.

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All the authors declare no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Hız, M., Karaismailoglu, B., Ulutas, S. et al. The effect of preoperative radiotherapy on local control and prognosis in high-grade non-metastatic intramedullary osteosarcoma of the extremities. Arch Orthop Trauma Surg 141, 1083–1089 (2021). https://doi.org/10.1007/s00402-020-03494-4

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