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Limb salvage surgery for osteosarcoma

Early results in Indian patients

Indian Journal of Orthopaedics volume 48, pages 266–272 (2014)Cite this article

Abstract

Background: While limb salvage surgery has long been established as the standard of care for osteosarcoma, large studies from Indian centers are few. Given the diverse socio economic milieu of our patients, it becomes significant to determine the feasibility and outcome of management of osteosarcoma in our population. We analyzed the early outcome of limb salvage surgery with multimodality treatment of osteosarcoma of the extremity/girdle bones at a tertiary North Indian Cancer Centre.

Materials and Methods: A total of 51 limb salvage surgeries performed during the months between November 2008 and November 2012 were studied. Neoadjuvant/adjuvant chemotherapy was given by the pediatric/adult medical oncology teams as applicable. The mean followup was 19.45 months (range 2–50 months). The oncological outcome was correlated with age, sex, size of tumor, stage at presentation, site, histological subtype, type of chemotherapy protocol followed and necrosis seen on postoperative examination of resected specimen. The functional outcome of the patients was evaluated using the musculoskeletal tumor society (MSTS) scoring system.

Results: Out of a total of 37 males and 14 females with an average age of 18.8 years, the 3 year overall survival was 66% and 3 year event free survival was 61.8%. In this group of patients with a short followup, a better oncological outcome was associated with good postoperative tumor necrosis, nonchondroblastic histology and age <14 years. The average MSTS score was highest in patients with proximal or distal femur prosthesis and the lowest in patients undergoing a knee arthrodesis.

Conclusion: The present study shows oncological and functional outcomes of limb salvage combined with chemotherapy in Indian patients with osteosarcoma comparable to those in world literature. Larger studies on Indian population with longer followup are recommended.

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Affiliations

  1. Department of Pediatric Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Rohini, New Delhi, India

    Sandeep Jain & Gauri Kapoor

  2. Department of Plastic and Reconstructive Surgery, Rajiv Gandhi Cancer Institute and Research Center, Rohini, New Delhi, India

    Sandeep Mehta

  3. Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Sector 5, Rohini, New Delhi, 110 085, India

    Akshay Tiwari, Rajesh Kumar & Kapil Kumar

Authors
  1. Akshay Tiwari
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  2. Sandeep Jain
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  3. Sandeep Mehta
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  4. Rajesh Kumar
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  5. Gauri Kapoor
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  6. Kapil Kumar
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Correspondence to Akshay Tiwari.

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Tiwari, A., Jain, S., Mehta, S. et al. Limb salvage surgery for osteosarcoma. IJOO 48, 266–272 (2014). https://doi.org/10.4103/0019-5413.132511

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  • DOI: https://doi.org/10.4103/0019-5413.132511

Key words

  • Limb salvage surgery
  • osteosarcoma
  • oncological outcome
  • neoadjuvant
  • chemotherapy