Primary fibrosarcoma of bone - Outcome after primary surgical treatment

To investigate outcome and evaluate prognostic factors in primary fibrosarc oma of bone, all patients at the authors' institution who had surgical trea tment for primary fibrosarcoma of bone from 1910 to 1995 were studied. Medi cal records, surgical reports, radiographs, and histologic slides of 92 pat ients (51 males, 41 females; mean age, 38 sears; range, 8-84 years) were re viewed. The most common tumor locations were the femur (28 patients), tibia (21 patients), and pelvis (14 patients). Sixty-one tumors (66%) were Ennek ing Stage IIB. Twenty-nine patients (31.5%) had adjuvant therapy: 16 had ra diation, nine had chemotherapy alone, and four had radiation and chemothera py. Amputation or disarticulation was performed in 61 patients (66%), wide excision was performed in 13 (14%), marginal excision was performed in 15 ( 16%), and intralesional excision was performed in three (3.3%). Local recur rence occurred in 14 patients (15%) at a median time of 7 months (range, 3- 21 months). Metastases developed in 58 of the 85 patients (68%) with Stage I or II tumors at presentation, at a median of 9 months (range, 1-51 months ). Survivorship analysis showed that the overall probability, of survival w as 33.4% at 5 years after surgery. Multivariate analysis showed that the ma in prognostic risk factors affecting overall survival included age older th an 40 years, tumor location in the axial skeleton, and high-grade tumor (Gr ade 3 or 4). With the high incidence of systemic failure after surgical tre atment, perioperative adjuvant treatment modalities should be considered.