[Local recurrences after salvage operations in the therapy of osteogenic sarcoma cases - an analysis of adverse...

Therapeutic approach in osteogenic sarcoma until 1982 was connected mainly with surgery. Introduction of chemotherapy to the therapeutic protocols of osteogenic sarcoma improved the 5 years survival of patients with osteogenic sarcoma from 20% to 60-70%. The approach to surgical treatment was also changed. The principle of this treatment is usually to perform an operation to spare the limb with an intraoperative frozen section examination of bone marrow. In our Institute during the last 14 years about 300 cases were diagnosed, out of which about 200 were treated surgically, among these about 50% underwent treatment by salvage operations. Only in 7 cases local recurrences of disease were confirmed. Five of these cases were tumours of distal metaphysis of the femur, one case of proximal metaphysis of the tibia and one case of proximal metaphysis of the humeral bone. The sex range M/F was: 5/2, the average age of onset about 14 years. Various factors playing a role in therapeutic adversities were analysed. Among these were: radical surgery, grade of differentiation of the tumour, histological subtype, soft tissue infiltration, reaction to preoperative therapy and the type of chemotherapy. The conducted analysis indicates the role played by sparing surgery in adversities in therapy (3 cases). Attention was also given to the distinct tendency of osteogenic sarcoma to produce vascular embolism which is a source of haematogenously spreading metastases. In 7 cases vascular tumour embolism caused the appaerance of metastatic focuses adjacent to the primary tumour. A certain role in therapeutic adverities is played by the lack of response to preoperative chemotherapy (4/7 cases). The influence of other factors needs further investigation.