RELATIONSHIP OF CHEMOTHERAPY-INDUCED NECROSIS AND SURGICAL MARGINS TOLOCAL RECURRENCE IN OSTEOSARCOMA

Purpose and Methods: To assess patients with high-grade osteosarcoma t reated at our institution for various prognostic factors for the devel opment of local recurrence of disease. Follow-up data were available f or all patients and the mean follow-up duration was 65 months in survi ving patients. Results: There were 28 local recurrences in this study (7%). Of these, only three patients (11%) were alive at the most recen t follow-up point, 28, 53, and 54 months after local recurrence. None of 59 patients who were treated primarily with a radical amputation an d none of 10 who underwent a rotationplasty developed local recurrence . Four of 48 patients (8%) who had wide amputations, one of whom had a n intralesional amputation, and 23 of 237 (10%) who had limb-salvage s urgery developed locally recurrent disease. Of 237 patients who underw ent limb-sparing resection, three prognostic factors for local control were identified. The strongest association with local recurrence was chemotherapy response (P < .0001), followed closely by surgical margin s (P = .0001). Older patients were more likely to have locally recurre nt disease (P = .033), with each decade of life older than the first d ecade having a relative risk of 1.5 times greater per decade (SE = 0.1 6; 95% confidence interval, 0.034 to .0650). Factors that were not ass ociated with local recurrence included sex, date of diagnosis, and ana tomic site of disease. Conclusion: Chemotherapy-induced tumor necrosis and surgical margins are important prognostic factors for local contr ol of patients with osteosarcoma.