Conservative surgical treatment of osteogenic sarcoma of the limb in children and adolescents

Purpose of the study Advances in chemotherapy protocols over the last 20 years have considerably improved the prognosis and functional outcome in patients with osteogenic sarcoma. We report here the results of a cooperative study conducted under the auspices of the French Society of Pediatric Oncology (SFOP). Twenty-nin e oncology centers participated in this retrospective national multicentric study. Materials and methods The study included 153 patients with osteogenic sarcoma of the limb who wer e treated by the OS87 protocol with conservative surgery between 1987 and 1 994. The OS87 protocol consisted in conservative or non-conservative surger y combined with pre- and postoperative chemotherapy. The following inclusio n criteria were used: age under 20 years, tumor localization in a limb (pel vis and spine excluded), no metastasis at diagnosis, biopsy proven osteogen ic sarcoma. Results Mean age at diagnosis was 13 years. The knee localization predominated (80 p. 100). 82.5 p. 100 of the patients had grade IIB disease (Enneking classi fication). For the 187 patients included in the protocol surgery was non-co nservative in 20 p. 100 of the cases and conservative in 80 p. 100. The cho ice of the surgical technique (arthroplasty allograft, autograft, resection without reconstruction) depended on the patient's age and school situation . Data analyzed here concerned only those patients who had conservative tre atment. Mean follow-up was 64 months. The actuarial survival curve plateaue d at 71 p. 100 at more than 6 years. Early and late complications were nume rous and variable (mechanical, infectious, local recurrence). Secondary amp utation was required in 10 p. 100 of the patients. The overall functional o utcome of the preserved limbs was nevertheless good with rapid restoration of self-sufficiency despite major Surgery and a high number of reoperations (about 65 p. 100 of cases). Discussion In light of the frequency and the seriousness of the complications, these r esults are modest. Patients and family should be advised of the risk, parti cularly the risk of secondary amputation which may be required early due to contaminated excision or at mid term due to major non-cancerological compl ications. As survival has been improved, functional capacity must be preser ved for several years. This orients surgery towards more "biological" recon struction which can provide greater longevity than arthroplasty.