PROGNOSTIC VALUE OF MANAGEMENT SCHEMES FOR LOCAL OSTEOSARCOMA: RETROSPECTIVE ANALYSIS IN A SINGLE CENTRE

Abstract

Purpose: Several studies have been conducted to search for factors affecting the prognosis of osteosarcoma. In this work, we attempted to assess the prognostic value of the biopsy technique and initial management on long-term prognosis of localised osteosarcoma of the limbs.

Material and methods: The series included 139 patients (88 males and 51 females, aged 4 to 58 years) with high-grade malignant osteosarcoma of the lower limbs treated or followed by our team between 1984 and 1998. Seventy-eight patients were referred to our unit for biopsy performed by a team surgeon after careful search for local extension and conception of the future extratumour en bloc resection. The 84 other patients were referred to our team after biopsy or after induction chemotherapy. There was no statistical significant difference between the two groups for known prognostic factors (localisation, tumour size, gender). All patients were given pre- and postoperative chemotherapy using the protocols generally applied at the time of their treatment. Three referred patients had already undergone amputation. All others were treated with conservative surgery even in case of fracture, very large tumour or young age. Patients were followed by their surgeon and chemotherapist independently with regular visits every three months for two years then every six months for two years and every year thereafter. Median follow-up was ten years (2.5–16.5 years).

Results: There were 12 local relapses (9%). Two were complications observed among the 75 patients followed from the start in our unit and ten were among the 84 secondary referral patients. Relapse-free survival reached 54% (46/84) in the referral patients compared with 73% (40/55) for the patients initially treated in our unit. For patients treated initially in our unit after 1986, the relapse-free survival rate reached 93%. Multivariate analysis demonstrated that the difference was significant (p < 0.02).

Conclusion: Initial management by an experimented team is a major prognosis factor for long-term survival and for risk of local recurrence in patients with high-grade malignant osteosarcoma of the limbs first seen without metastasis. When the diagnosis of osteosarcoma cannot be ruled out, these patients should be referred to a team specialised in malignant bone tumours before biopsy.