Long-term results of combined therapy for primary osteosarcoma in extremities

Objective: To evaluate the survival rates, functional outcome, and complications between the combined and non-combined treatment of primary osteosarcoma of the extremities.

Methods: From 1977 through 1992, 170 patients with high-graded, nonmetastatic osteosarcoma were treated. Their average age at diagnosis was 21 years old (ranging from 6 to 52). Tumors were observed at distal femurs in 80 patients (47%), proximal tibia in 51 (30%), proximal humors in 10 and other locations in 22. Combined therapy (en bloc resection of tumor with preoperative and postoperative neoadjuvant chemotherapy) was given 104 patients and non-combined therapy (tumor resection only) to 66. Ninety-four patients underwent limb salvage surgery. In 76 patients who received amputations or disarticulations 33 received chemotherapy.

Results: The 5-and 10-year-survival rates were 61% and 53% in the combined therapy group and 28% and 26% in the non-combined therapy group. Local recurrence rate was 23% in limb salvage surgery group and 5.2% in amputation group. Functional evaluation of 80 patients showed that the patients who underwent salvage surgery had higher functional scores than those who had an amputation according to MSTS scoring system (1993). The average scores reached 71% in the salvage surgery group and 53% in the amputation group.

Conclusions: In this study, long-term that combined therapy raised the survival rate of the patients with osteosarcoma. The ase of en bloc resection of bone tumor and reconstructive technique, has enable limb salvage procedures possible to produce excellent functional outcomes. The patients who well have responses to preoperative chemotherapy may have a higher survival rate.