G. Bacci et al., Local and systemic control for osteosarcoma of the extremity treated with neoadjuvant chemotherapy and limb salvage surgery: The Rizzoli experience, ONCOL REP, 7(5), 2000, pp. 1129-1133
Five-hundred and twenty-six patients with nonmetastatic osteosarcoma of the
extremities treated at Istituto Ortopedico Rizzoli from 1983 to 1995 with
neoadjuvant chemotherapy and limb salvage, were retrospectively studied to
evalute the rate of local and systemic control. At a mean follow-up of 9.5
years (3-17), 320 patients remained continuously free of disease and 206 re
lapsed. The 5-year disease-free survival and overall survival were 64% and
70% respectively. In patients who relapsed, there were 31 local recurrences
(6%). The rate of local failures was significantly higher in the 79 patien
ts with inadequate surgical margins (marginal, inralesional, and contaminat
ed margins) than in the 486 patients with wide surgical margins (2.6% vs. 2
5.0%; P<0.0001). Twenty-nine of the 31 patients (94%) with local recurrence
also had metastases and died of the tumor. In comparison with patients who
only had a systemic relapse, patients with local recurrences had a higher
rate of metastases located in bones (41% vs. 7%; P<0.001), and a worse post
-relapse outcome (5-year overall survival: 6% vs. 24%; P<0.04). We conclude
d that in osteosarcoma of the extremity treated with neoadjuvant chemothera
py: i) limb salvages procedures do not compromise the outcome of patients,
provided the achievement of adequate surgical margins; ii) local recurrence
s are a marker either of the inadequacy of local treatment or of the high l
ocal and systemic aggressiveness of the tumor.