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01-06-2014 | Bone and Soft Tissue Sarcomas

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

Authors: Amos H. P. Loh, MD, Fariba Navid, MD, Chong Wang, MA, Armita Bahrami, MD, Jianrong Wu, PhD, Michael D. Neel, MD, Bhaskar N. Rao, MD

Published in: Annals of Surgical Oncology | Issue 6/2014

Abstract

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.

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Title: Management of Local Recurrence of Pediatric Osteosarcoma Following Limb-Sparing Surgery
Authors: Amos H. P. Loh, MD
Fariba Navid, MD
Chong Wang, MA
Armita Bahrami, MD
Jianrong Wu, PhD
Michael D. Neel, MD
Bhaskar N. Rao, MD
Publication date: 01-06-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 6/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-3550-8

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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