Skip to main content

Advertisement

SpringerLink
Log in

Limb salvage surgery for osteosarcoma

Early results in Indian patients

  • Symposium - Osteosarcoma
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Allison DC, Carney SC, Ahlmann ER, Hendifar A, Chawla S, Fedenko A, et al. A meta-analysis of osteosarcoma outcomes in the modern medical era. Sarcoma 2012;2012:704872.

    Article  Google Scholar 

  2. Picci P. Osteosarcoma (osteogenic sarcoma). Orphanet J Rare Dis 2007;2:6.

    Article  Google Scholar 

  3. Jaffe N, Puri A, Gelderblom H. Osteosarcoma: Evolution of treatment paradigms. Sarcoma 2013;2013:203531.

    Article  Google Scholar 

  4. Bacci G, Forni C, Ferrari S, Longhi A, Bertoni F, Mercuri M, et al. Neoadjuvant chemotherapy for osteosarcoma of the extremity: Intensification of preoperative treatment does not increase the rate of good histologic response to the primary tumor or improve the final outcome. J Pediatr Hematol Oncol 2003;25:845–53.

    Article  Google Scholar 

  5. Agarwal M, Anchan C, Shah M, Puri A, Pai S. Limb salvage surgery for osteosarcoma: Effective low-cost treatment. Clin Orthop Relat Res 2007;459:82–91.

    Article  Google Scholar 

  6. McTiernan A, Jinks RC, Sydes MR, Uscinska B, Hook JM, van Glabbeke M, et al. Presence of chemotherapy-induced toxicity predicts improved survival in patients with localised extremity osteosarcoma treated with doxorubicin and cisplatin: A report from the European Osteosarcoma Intergroup. Eur J Cancer 2012;48:703–12.

    Article  CAS  Google Scholar 

  7. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 1993;286:241–6.

    Google Scholar 

  8. Simon MA, Aschliman MA, Thomas N, Mankin HJ. Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur. J Bone Joint Surg Am 1986;68:1331–7.

    Article  CAS  Google Scholar 

  9. Nathan SS, Healey JH. Demographic determinants of survival in osteosarcoma. Ann Acad Med Singapore 2012;41:390–9.

    PubMed  Google Scholar 

  10. Ferrari S, Bertoni F, Mercuri M, Picci P, Giacomini S, Longhi A, et al. Predictive factors of disease-free survival for nonmetastatic osteosarcoma of the extremity: An analysis of 300 patients treated at the Rizzoli Institute. Ann Oncol 2001;12:1145–50.

    Article  CAS  Google Scholar 

  11. Meyers PA, Gorlick R, Heller G, Casper E, Lane J, Huvos AG, et al. Intensification of preoperative chemotherapy for osteogenic sarcoma: Results of the Memorial Sloan-Kettering (T12) protocol. J Clin Oncol 1998;16:2452–8.

    Article  CAS  Google Scholar 

  12. Bacci G, Longhi A, Versari M, Mercuri M, Briccoli A, Picci P. Prognostic factors for osteosarcoma of the extremity treated with neoadjuvant chemotherapy: 15-year experience in 789 patients treated at a single institution. Cancer 2006;106:1154–61.

    Article  Google Scholar 

  13. Mangat KS, Jeys LM, Carter SR. Latest developments in limb-salvage surgery in osteosarcoma. Expert Rev Anti cancer Ther 2011;11:205–15.

    Article  Google Scholar 

  14. Brien EW, Terek RM, Healey JH, Lane JM. Allograft reconstruction after proximal tibial resection for bone tumors. An analysis of function and outcome comparing allograft and prosthetic reconstructions. Allograft reconstruction after proximal tibial resection for bone tumors 1994;303:116–27.

    Google Scholar 

  15. Manfrini M, Tiwari A, Ham J, Colangeli M, Mercuri M. Evolution of surgical treatment for sarcomas of proximal humerus in children: Retrospective review at a single institute over 30 years. J Pediatr Orthop 2011;31:56–64.

    Article  Google Scholar 

  16. Shehadeh A, Noveau J, Malawer M, Henshaw R. Late complications and survival of endoprosthetic reconstruction after resection of bone tumors. Clin Orthop Relat Res 2010;468:2885–95.

    Article  Google Scholar 

  17. Lindner NJ, Ramm O, Hillmann A, Roedl R, Gosheger G, Brinkschmidt C, et al. Limb salvage and outcome of osteosarcoma. The University of Muenster experience. Limb salvage and outcome of osteosarcoma 1999;358:83–9.

    Google Scholar 

  18. Jeys LM, Grimer RJ, Carter SR, Tillman RM. Periprosthetic infection in patients treated for an orthopaedic oncological condition. J Bone Joint Surg Am 2005;87:842–9.

    Article  CAS  Google Scholar 

  19. Graci C, Maccauro G, Muratori F, Spinelli MS, Rosa MA, Fabbriciani C. Infection following bone tumor resection and reconstruction with tumoral prostheses: A literature review. Int J Immunopathol Pharmacol 2010;23:1005–13.

    Article  CAS  Google Scholar 

  20. Rusch VW. Pulmonary metastasectomy. Current indications. Pulmonary metastasectomy 1995;107 6 Suppl:322S–31.

    CAS  Google Scholar 

  21. Buddingh EP, Anninga JK, Versteegh MI, Taminiau AH, Egeler RM, van Rijswijk CS, et al. Prognostic factors in pulmonary metastasized high-grade osteosarcoma. Pediatr Blood Cancer 2010;54:216–21.

    PubMed  Google Scholar 

  22. Picci P, Vanel D, Briccoli A, Talle K, Haakenaasen U, Malaguti C, et al. Computed tomography of pulmonary metastases from osteosarcoma: The less poor technique. A study of 51 patients with histological correlation. Computed tomography of pulmonary metastases from osteosarcoma: The less poor technique 2001;12:1601–4.

    CAS  Google Scholar 

Download references

Author information

Authors and 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
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sandeep Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sandeep Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rajesh Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gauri Kapoor
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kapil Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Akshay Tiwari.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

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

Key words

Search

Navigation