Intralesional margin after excision of a high-grade osteosarcoma: Is it a catastrophe?

Area of Science:

• Orthopedic Oncology
• Surgical Pathology
• Medical Oncology

Background:

• High-grade osteosarcoma (OS) treatment typically involves chemotherapy and surgery.
• Outcomes for OS with inadequate (intralesional) surgical margins are not well-defined.

Purpose of the Study:

• To evaluate the outcomes of high-grade osteosarcoma patients with intralesional margins after planned wide resection.
• To identify factors influencing local recurrence and survival in this patient cohort.

Main Methods:

• Retrospective analysis of 53 patients with high-grade OS of the trunk and extremities treated between 1990-2017.
• Data sourced from the Scandinavian Sarcoma Group registry and Royal Orthopaedic Hospital databases.

Main Results:

• Local recurrence occurred in 13/53 patients, all of whom were poor responders to neoadjuvant chemotherapy.
• No patients with a good chemotherapy response experienced relapse.
• Postoperative radiotherapy did not significantly improve local disease control.

Conclusions:

• A good response to chemotherapy can mitigate poor outcomes associated with intralesional margins in high-grade OS.
• Watchful waiting may be a viable strategy for good responders with inadequate margins.
• Individualized treatment approaches are recommended for poor responders due to their elevated recurrence risk.