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

Area of Science:

• Orthopedic Oncology
• Surgical Oncology
• Chemotherapy Research

Background:

• Osteosarcoma treatment often involves neoadjuvant chemotherapy followed by surgical resection.
• Evaluating limb salvage techniques like marginal resection is crucial for long-term patient outcomes.
• Assessing the efficacy of different chemotherapy regimens in conjunction with marginal resection is important.

Purpose of the Study:

• To evaluate the long-term outcomes of osteosarcoma patients treated with marginal resection after effective preoperative chemotherapy.
• To compare the outcomes between two chemotherapy protocols: MMIA (high-dose methotrexate, adriamycin, ifosfamide, and cisplatin) and DIA (cisplatin, adriamycin, and ifosfamide).
• To assess the impact of marginal resection on limb function, survival rates, and recurrence in osteosarcoma patients.

Main Methods:

• Retrospective review of 50 osteosarcoma patients undergoing marginal resection post-chemotherapy.
• Patients were divided into two groups based on chemotherapy regimen: MMIA (n=18) and DIA (n=32).
• Limb function assessed using the MSTS93 system; survival analyzed using Kaplan-Meier method.

Main Results:

• Median follow-up of 5.5 years.
• Overall 5-year survival: 61.7%; event-free survival: 57.7%.
• Local recurrence rate: 8.5%; pulmonary metastases: 42.6%; excellent/good limb function: 57.7%.

Conclusions:

• Marginal resection is feasible for osteosarcoma patients with favorable chemotherapy response.
• This approach did not negatively impact survival or local recurrence rates.
• Patients experienced a good clinical course with preserved limb function.