The effect of preoperative radiotherapy on local control and prognosis in high-grade non-metastatic intramedullary osteosarcoma of the extremities

• Published in: Archives of orthopaedic and trauma surgery Vol. 141; no. 7; pp. 1083 - 1089
• Main Authors: Hız, Murat, Karaismailoglu, Bedri, Ulutas, Suat, Camurdan, Vedat Burkay, Gorgun, Baris, Oner Dincbas, Fazilet
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2021; Springer Nature B.V
• Subjects: Bone cancer; Chemotherapy; Medical prognosis; Medicine; Medicine & Public Health; Metastasis; Orthopaedic Surgery; Orthopedics; Radiation therapy; Sarcoma; Preoperative radiotherapy; Neoadjuvant; Osteosarcoma; Survival
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-020-03494-4

Introduction This study aimed to analyse the effect of preoperative radiotherapy on survival, recurrence and necrosis rates in osteosarcoma patients treated with neoadjuvant chemotherapy and limb-salvage surgery. Materials and methods Osteosarcoma patients who referred to our clinic from 1998 to 2015 were investigated retrospectively. 141 patients with non-metastatic osteosarcoma of the limb who received neoadjuvant chemotherapy and underwent limb-sparing surgery with or without preoperative radiotherapy were included in the study. 73 patients had neoadjuvant chemotherapy only (CT group), while 68 patients had additional preoperative radiotherapy (CT + RT group). 5-year survival, disease-free survival, limb survival, local recurrence, metastasis, complication and necrosis rates were compared between the two groups. Results Overall 5-year survival, 5-year disease-free survival, 5-year limb survival rates were 68.5, 64.3, 65.7 for CT group and 72.1, 67.6, 64.7 for CT + RT group, respectively. Preoperative radiotherapy gave similar survival and disease-free survival rates. Limb survival, recurrence and metastasis rates were similar between the groups. The necrosis rate of the lesions was significantly higher in the CT + RT group compared to the CT group. Conclusion Preoperative radiotherapy can provide a higher necrosis rate and may allow the resection of unresectable lesions in the treatment of osteosarcoma. CT + RT provided similar 5-year survival despite the larger tumour size compared to CT group. Due to the higher wound complication rate (8.2% in CT, 23.5% in CT + RT group, p  = 0.01), CT + RT should be restricted to the lesions with large size or close proximity to neurovascular structures. Level of evidence Level III; Therapeutic, Retrospective comparative study.