LOCAL RECURRENCE OF OSTEOSARCOMA: SURVIVAL RATE AND MANAGEMENT

Abstract

To assess the clinical features, development of metastases, and survival rate of patients with local recurrence after the resection of osteosarcoma in a large series.

Five hundred and thirty (530) patients with high-grade osteosarcoma were treated between 1989 and 1998. Fifty-four patients (10%) developed local recurrence after resection and adjuvant chemotherapy. There were 38 men and 16 women with a mean age of 19 years (range 6–50). The mean follow up was 39 months (range 7–120 months). Forty-three patients (79%) had clear resection margins microscopically, while in 8 patients (15%) microscopic tumour was found at the resection margin, and contaminated excision was performed in 3 patients. Histological response was category 1 in 24% of the patients, and category 2 in 76%. Clinical features, treatment, and prognosis were analyzed. Survival rates were examined using Kaplan-Meier Analysis.

The average interval between the first resection and local recurrence was 15 months (range 2–109 months). Forty-one patients (76%) had local recurrence in deep soft tissue, 7 in bone, and 6 in subcutaneous tissue. Twenty-six patients (49%) had lung metastasis at the time of local recurrence, while 21 patients (38%) developed it later. Thirty patients (57%) were treated with resection of the recurrent lesion and 18 (32%) were treated with amputation. 1-, 3-, and 5-year survival rates after local recurrence were 0.57, 0.38, and 0.22 respectively.

1. 87% of patients with local recurrence developed metastases either concurrently or at a later date. Immediate amputation did achieve local tumor control. However, the survival rate was not statistically higher.

2. 87% of the local recurrence arose in soft tissue. Therefore, careful attention should be paid to secure the wide margin around biopsy tract, muscle insertion to the affected bone, and neurovascular bundle at the time of initial resection.