LIMB-SALVAGE FOR OSTEOSARCOMA

Limb-alvage surgery plays an important role in the treatment of ostaosarcoma. Among 104 patients with osteosarcoma we managed from 1974 to 1993, 60 were treated with limb-salvage procedure. 44 patients with HB tumor received adjuvant chemotherapy, and the five-ear survival rate was 46.69%. The local recurrence rate of these 60 patients was 15%, the infection rate 11.7%, and the prosthetic mechanical complication was 133%. Our results suggest that limb-salvage procedures are not only possible but also can provide patients with better function.

Limb salvage surgery of patients with osteosarcoma sustaining pathologic fractures

Objective: The aim of this study was to report the oncological result of the treatment of 12 patients with osteosarcoma sustaining pathologic fracture. Methods: There were 9 male and 3 female patients, the average age was 17.6 years (ranged, 11–34 years). All patients received neoadjuvant chemotherapy, wide margin resection was achieved and skeletal reconstruction was done with locally designed and custom-manufactured prosthesis. Follow-up examination was carried out at an average of 36 months (range from 12–94 months). Results: Nine patients had survived and of these 8 patients were free from disease while one patient was alive with disease. The functional result (using the 30-point rating system of the Musculoskeletal Tumor Society) was excellent in three (25%), good in six (50%), fair in three (25%). Conclusion: The performance of a limb-salvage procedure in a patient with pathologic fracture, particularly for one that unites following chemotherapy, does not significantly increase the risk of local recurrence or survival.

Transition from Tumor Tissue to Bone Marrow in Patients with Appendicular Osteosarcoma after Neoadjuvant Chemotherapy

Background：Limb-salvage surgery is the standard procedure for the treatment of appendicular osteosarcoma.Precise resection is the trend in limb-salvage surgery.The aim of this study was to evaluate a large series of cases to identify the histological relationship between the tumor and marrow and determine the intramedullary transition type and width from the tumor to normal marrow in patients with osteosarcoma after neoadjuvant chemotherapy.Methods：One hundred and six osteosarcoma specimens were evaluated.The tissue specimens were sectioned through the coronal axis by an electronic saw.The tissue was immersed in formalin solution for fixation and subsequently decalcified.The interface between the tumor and normal bone marrow was grossly determined and submitted for microscopic evaluation to detect the relationship between the tumor and bone marrow and identify the transition type and width.All histological slides were examined by experienced orthopedic pathologists.Results：Histologically,the interface between the tumor and normal bone marrow was classified into two patterns：＂clear＂ and ＂infiltrated.＂The clear pattern,characterized by a clear boundary between the tumor and marrow,was identified in sixty cases （56.6%）.A subtype of the clear type,characterized by fibrous bands between the tumor and marrow,was found in 13 cases （12.3%）.The infiltrated pattern,characterized by a boundary with tumor cell clusters embedded in the marrow,was found in 46 cases （43.4%）.The infiltrating depth varied from 1 to 4 mm （mean,2.6 ＋ 0.7 mm）.No tumor cells were observed in the normal bone marrow areas next to the interface.Conclusions：The transition from osteosarcoma tissue to bone marrow after neoadjuvant chemotherapy can be divided into two histological patterns：clear and infiltrated.The greatest infiltration width was 4 mm from tumor to normal marrow in this study.This depth should be considered in the presurgical plan.