Management of Local Recurrence of Pediatric Osteosarcoma Following Limb-Sparing Surgery

• Published in: Annals of surgical oncology Vol. 21; no. 6; pp. 1948 - 1955
• Main Authors: Loh, Amos H. P., Navid, Fariba, Wang, Chong, Bahrami, Armita, Wu, Jianrong, Neel, Michael D., Rao, Bhaskar N.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.06.2014; Springer Nature B.V
• Subjects: Adolescent; Amputation; Bone and Soft Tissue Sarcomas; Bone Neoplasms - pathology; Bone Neoplasms - surgery; Child; Female; Femur; Humans; Humerus; Male; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local - surgery; Oncology; Osteosarcoma - secondary; Osteosarcoma - surgery; Retrospective Studies; Soft Tissue Neoplasms - secondary; Soft Tissue Neoplasms - surgery; Surgery; Surgical Oncology; Survival Rate; Tibia; Young Adult; Local Recurrence; Resection Margin; Extremity Osteosarcoma; Osteosarcoma; Pediatric Osteosarcoma
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-014-3550-8

Background The optimal management of locally recurrent pediatric osteosarcoma is not established, especially after prior limb-sparing surgery. We describe our experience in the management of these patients and identify prognostic indicators of post-recurrence survival. Methods We conducted a retrospective, single-institution review of patients with locally recurrent osteosarcoma after limb-salvage surgery who were treated between October 1989 and January 2012. The management of each recurrence was evaluated, and patient, disease, and treatment factors were correlated with post-recurrence survival (PRS). Results Of 200 patients who underwent limb-sparing procedures, 18 (9 %) had biopsy-proven local recurrence. Recurrences occurred in soft tissue in 15 patients (83.3 %). Six patients (33.3 %) were amenable to repeat limb-sparing surgery. Median time to local recurrence was 1.4 (range 0.6–10.4) years. Median PRS was 11.8 months (range 3.7 months–12.1 years). Post-recurrence survival was significantly associated with the length of resection margins and was longer when recurrent tumors were resected with margins of ≥1 cm, compared with subcentimeter or positive margins ( P  = 0.03). Median PRS was longer in patients who underwent amputations (2.44 years) than those who underwent repeat limb-sparing surgery (0.86 years), and in patients who had distant metastases resected (2.7 years) than those who did not (0.85 years); however, differences were not significant. Conclusions Local management of recurrent osteosarcoma in a previously reconstructed limb is highly individualized. A sufficiently wide resection is important for local control of recurrences, independent of the type of surgery. Maintaining control of distant metastases may also contribute to improved survival.