Does increased rate of limb-sparing surgery affect survival in osteosarcoma?

Abstract

Background: The emergence of limb salvage surgery as an option for patients with osteosarcoma is attributable to preoperative chemotherapy and advancements in musculoskeletal imaging and surgical technique. While the indications for limb salvage have greatly expanded it is unclear whether limb salvage affects overall survival.

Questions/purposes: We asked whether over the past three decades limb-sparing procedures in high-grade osteosarcoma had increased, and whether this affected survival and ultimate amputation.

Methods: We retrospectively reviewed 251 patients with high-grade osteosarcoma treated from 1980 to 2004 with a multidisciplinary approach, including neoadjuvant chemotherapy. We compared survival rates, limb-salvage treatment, and amputation after limb-sparing procedure during three different periods of time. Fifty-three patients were treated from 1980 to 1989, 97 from 1990 to 1999, and 101 from 2000 to 2004. Thirty-seven patients were treated with primary amputations and 214 with primary limb salvage.

Results: The 5-year survival rate in the first period was 36%, whereas in the 1990 s, it was 60% and 67% from 2000-2004. Limb salvage surgery rate in the 1980s was 53% (28 of 53), whereas in the 1990 s, it was 91% (88 of 97) and 97% from 2000-2004 (98 of 101). In the limb salvage group, 22 of the 214 patients (10%) required secondary amputation; the final limb salvage rate in the first period was 36% (19 of 53), whereas in the 1990 s, it was 81% (79 of 97) and 93% from 2000-2004 (94 of 101).

Conclusions: Patients with osteosarcoma treated in the last two periods had higher rates of limb salvage treatment and survival, with lower secondary amputation.

Fig. 1

This figure shows the total number of patients treated with amputation and limb salvage procedure in each period. Note the increasing number of limb salvage procedure in the last two periods. CI = confidence interval.

Fig. 2

Kaplan-Meier curve showing the overall survival of the entire series. The I bars indicate the 95% confidence intervals.

Fig. 3

Kaplan-Meier curve showing the differences in survivorship according to each analyzed period. No difference was noted in the last two periods. The I bars indicate the 95% confidence intervals.

Fig. 4

This figure shows the final number of patients that preserved their limb and the number of secondary amputations in each study period. Note that the number of secondary amputations is lower in the last two periods had decreased. CI = confidence interval.