Current trends in the management of adamantinoma of long bones - An international study

Background: Adamantinoma of long bones is a rare tumor. Published reviews o f the orthopaedic management of adamantinoma have involved limited follow-u p of small numbers of patients. The oncological aggressiveness of this tumo r is unknown. Limb salvage is currently the treatment of choice for most ad amantinomas. The purpose of this study was to evaluate the characteristics of adamantinoma of long bones as well as the oncological outcome and the co mplications of limb salvage operations, Methods: A retrospective study was designed to evaluate the clinical outcom es of limb salvage operations for the treatment of adamantinoma. Data on se venty biopsy-proven cases of adamantinoma treated between 1982 and 1992 at twenty-three different cancer centers in Europe and North America were obta ined. Results: The median duration of follow-up was 7.0 years, The male:female ra tio was 3:2, and the mean age was thirty-one Sears. Limb salvage was attemp ted in 91 percent (sixty-four) of the seventy patients, and the final rate of limb preservation was 84 percent (fifty-nine of seventy), Wide operative margins were obtained in 92 percent (fifty-eight) of sixty-three patients. An intercalary allograft was used to reconstruct the segmental bone defect in 51 percent (thirty-six) of the seventy patients. Reconstruction-related complications occurred in 48 percent (thirty) of sixty-two patients, Nonun ion and fracture were the most common complications, occurring in 24 percen t (fifteen) and 23 percent (fourteen) of sixty-two patients, respectively. Kaplan-Meier analysis demonstrated a rate of local recurrence of 18.6 perce nt at ten years. Wide operative margins were associated with a lower rate o f local recurrence than marginal or intralesional margins were (p < 0.00005 ). Kaplan-Meier analysis showed a survival rate of 87.2 percent at ten year s. There were no significant relationships between survival and the stage o f the tumor (p = 0.058), duration of symptoms (p = 0.90), gender (p = 0.79) , or wide operative margins (p = 0.14). Conclusions: Current treatment of adamantinoma, including en bloc tumor res ection with wide operative margins and limb salvage, provides lower rates o f local recurrence than has been previously reported, In the present study the limb preservation rate was 84 percent (fifty-nine of seventy), and the survival rate was 87.2 percent at ten Sears. The rate of complications rela ted to the limb reconstruction was high.