Marginal excision for osteosarcoma with caffeine assisted chemotherapy

The authors report on intentional marginal excision for osteosarcoma in con junction with caffeine assisted chemotherapy for the purpose of preservatio n of good limb function. Twenty-seven patients with osteosarcoma (22 patien ts with Stage IIB and five with Stage IIIB) preoperatively were given three -to-five courses of intraarterial cisplatin and caffeine without or with do xorubicin. For 26 (96%) responders to the chemotherapy, limb salvage surger y was conducted by means of an intentional marginal procedure, which led to the preservation of important structures such as major neurovascular bundl es, tendons, ligaments, muscles, and the epiphysis. Tumors were located in the distal femur in 11 patients, the proximal tibia in eight, the proximal fibula in four, the proximal humerus in two, and the proximal femur in one patient. The histologic response of these 26 patients to the preoperative c hemotherapy showed no viable cells in 19 patients with Stage lip osteosarco ma and only scattered foci of viable cells in two patients with Stage IIB a nd five patients with Stage IIIB osteosarcoma. As for reconstruction, distr action osteogenesis was performed in eight patients, allograft or autoclave d bone and prosthesis composite in four, autoclaved bone in two, osteochond ral allograft in two, megaprosthesis in six, and resection alone in four pa tients. The average functional evaluation of the 26 patients was 91% of nor mal. Local tumor recurrence was seen in one patient, whereas 18 patients wi th Stage IIB osteosarcoma remain diseasefree with a mean followup of 61 mon ths. Two patients with Stage IIB osteosarcoma and four patients with osteos arcoma Stage IIIB died of the disease. Intentional marginal excision for os teosarcoma in conjunction with caffeine assisted chemotherapy is advantageo us because it results in the preservation of healthy important structures, with joint preservation possible in selected cases. This approach should he lp to improve the success rate of limb salvage surgery for osteosarcoma and to preserve the function of the affected limb.