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. 2014 Nov 11:12:341.
doi: 10.1186/1477-7819-12-341.

Marginal resection for osteosarcoma with effective neoadjuvant chemotherapy: long-term outcomes

Ming Xu, SongFeng Xu, XiuChun Yu  1
Affiliations

Marginal resection for osteosarcoma with effective neoadjuvant chemotherapy: long-term outcomes

Ming Xu et al. World J Surg Oncol. .

Abstract

Background: We report the long-term outcomes of patients with osteosarcoma who underwent effective preoperative chemotherapy and subsequently underwent marginal resection.

Methods: We reviewed the records of 50 patients with osteosarcoma who underwent marginal resection following effective preoperative chemotherapy; 18 were treated with the MMIA (high-dose methotrexate (HD-MTX), adriamycin (ADR), ifosfamide (IFO)) and cisplatin (DDP), and 32 patients were treated with the DIA (DDP, ADR and IFO). protocol. The functions of the affected limb were evaluated using the revised MSTS93 system. The Kaplan-Meier method was used for survival analysis.

Results: After a median follow-up of 5.5 years, the rates were: overall 5-year cumulative survival 61.7%, event-free survival 57.7%, recurrence 8.5%, pulmonary metastases 42.6%, and excellent to good function of the affected limb 57.7%.

Conclusions: Our results showed that marginal resection can be performed in patients with osteosarcoma who obtain clinically favorable responses to chemotherapy. Patients had a good clinical course and there was no negative effect on rates of survival or local recurrence.

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Figures

Figure 1
Figure 1
Osteosarcoma arising from the left distal femur in a 15-year-old boy. (A,B) Before chemotherapy. (A) Magnetic resonance imaging (MRI) scan of the tumor obtained before neoadjuvant chemotherapy; arrows show lesions in longest diameter. (B) Tumor cells (hematoxylin and eosin (H&E), original magnification × 40). (C,D) After chemotherapy. (C) MRI scan of the same tumor after chemotherapy showed that there was no tumor extension into the epiphysis. Extensive calcification and the significantly reduced lesion (arrows, the sum of the longest diameter ≥30% reduction) indicated a good response to therapy. (D) Significant tumor cell degeneration and necrosis (H&E, original magnification × 40).
Figure 2
Figure 2
Results for a patient treated for osteosarcoma. (A) The epiphysis of the distal femur was preserved by marginal resection; (B) the remaining epiphysis; and (C) the resected tumor. (D) The radiograph shows that after an intramedullary nail and screws had been inserted into the residual epiphysis and the bone defect filled with bone cement (no barium), the implanted bone healed successfully.
Figure 3
Figure 3
Overall survival and event-free survival of patients with osteosarcoma treated in our hospital.
See this image and copyright information in PMC

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