Classifying the location of osteosarcoma with reference to the epiphyseal plate helps determine the optimal skeletal resection in limb salvage procedures

Kumta, S. M.; Chow, TC; Griffith, J. F.; Li, Chi Kong; Kew, J.; Pc, Leung

doi:10.1007/s004020050420

Cited by 45 publications

(44 citation statements)

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“…For our series, the rate of local tumor recurrence (0%) was comparable to rates (0%-8%) reported in other studies [6,10,11] in which bone sarcomas were treated with jointpreserving resection and allograft reconstruction. This indicates joint-preserving surgery using computer navigation may be a viable and safe option for select patients with bone sarcomas.…”

Section: Discussionsupporting

confidence: 87%

“…With the advent of effective neoadjuvant chemotherapy and accurate MRI [8], a close but tumor-free margin resection is possible while sparing the juxtaarticular bone and joint as in some metaphyseal osteosarcomas around the knee [2,[9][10][11]15]. However, it is difficult to relate the tumor margins on preoperative CT and/or MR images to the actual extent of the tumor in the bone and to precisely carry out the resection in the operating room without the use of an image guidance or surgical navigation system.…”

Section: Introductionmentioning

confidence: 99%

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Joint-preserving Tumor Resection and Reconstruction Using Image-guided Computer Navigation

Wong

Kumta

2013

Clinical Orthopaedics &Amp; Related Research

100

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Background Joint-preserving surgery is performed in select patients with bone sarcomas of extremities and allows patients to retain the native joint with better joint function. However, recurrences may relate to achieving adequate margins and there is frequently little room for error in tumors close to the joint surface. Further, the tumor margin on preoperative CT and/or MR images is difficult to transpose to the actual extent of tumor in the bone in the operating room.Questions/purposes We therefore determined whether joint-preserving tumor surgery could be performed accurately under image-guided computer navigation and determined local recurrences, function, and complications. Methods We retrospectively studied eight patients with bone sarcoma of extremities treated surgically by navigation with fused CT-MR images. We assessed the accuracy of resection in six patients by comparing the cross sections at the resection plane with complementary prosthesis templates. Mean age was 17 years (range, 6-46 years). Minimum followup was 25 months (mean, 41 months; range, 25-60 months). Results The achieved resection was accurate, with a

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Joint-preserving Tumor Resection and Reconstruction Using Image-guided Computer Navigation

Wong

Kumta

2013

Clinical Orthopaedics &Amp; Related Research

100

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“…Canadell et al [5] performed transepiphyseal resection in 12 high-grade osteosarcomas and had one local recurrence in their series. Our incidence of local recurrences is similar to that observed in other patients with osteosarcomas treated with limb-sparing surgery with other techniques [2,5,8,12,14]. Ferrari et al [8] reported 18 local recurrences (8%) in 230 patients who had conservative surgery.…”

Section: Discussionsupporting

confidence: 86%

“…The most common tumor resection technique used for a metaphyseal osteosarcoma of the distal femur or proximal tibia is the intraarticular resection of the distal part of the femur, proximal part of the tibia, or both [11,23]. However, intercalary tumor resection, with preservation of the epiphysis and knee, is an alternative in patients without tumor involvement of the distal part of the femur or the proximal part of the tibia [1,5,7,14,24,26]. The technique is possible in selected patients owing to advances in preoperative imaging [9,10,[18][19][20][21][22], which allows the surgeon to determine tumor margins and plan tumor resection that preserve a patient's uninvolved epiphysis.…”

Section: Introductionmentioning

confidence: 99%

Survival, Recurrence, and Function After Epiphyseal Preservation and Allograft Reconstruction in Osteosarcoma of the Knee

Aponte-Tinao

Ayerza

Múscolo

et al. 2015

Clinical Orthopaedics &Amp; Related Research

111

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Background Bone tumor resections for limb salvage have become the standard treatment. Recently, intercalary tumor resection with epiphyseal sparing has been used as an alternative in patients with osteosarcoma. The procedure maintains normal joint function and obviates some complications associated with osteoarticular allografts or endoprostheses; however, long-term studies analyzing oncologic outcomes are scarce, and to our knowledge, the concern that a higher local recurrence rate may be an issue has not been addressed. Questions/purposes We wanted to assess (1) the overall survival in patients treated with this surgical technique; (2) the percentage of local recurrence and limb survival, specifically the incidence of recurrence in the remaining epiphysis; (3) the frequency of orthopaedic complications, and, (4) the functional outcomes in patients who have undergone intercalary tumor resection. MethodsWe analyzed all 35 patients with osteosarcomas about the knee (distal femur and proximal tibia) treated at our center between 1991 and 2008 who had resection preserving the epiphysis and reconstruction with intercalary allografts. Minimum followup was 5 years, unless death occurred earlier (mean, 9 years; range, 1-16 years), and no patients were lost to followup. During the study period, our indications for this approach included patients without metastases, with clinical and imaging response to neoadjuvant chemotherapy, that a residual epiphysis of at least 1 cm thickness could be available after a surgical margin width in bone of 10 mm was planned, and 16% of patients (35 of 223) meeting these indications were treated using this approach. Using a chart review, we ascertained overall survival of patients, oncologic complications such as local recurrence and tumor progression, limb survival, and orthopaedic complications including infection, fracture, and nonunion. Survival rates were estimated using the Kaplan-Meier method. Patient function was evaluated using the Musculoskeletal Tumor Society (MSTS)-93 scoring system. Results Overall survival rate of the patients was 86% (95% CI, 73%-99%) at 5 and 10 years. Five patients died of disease. No patient had a local recurrence in the remaining bony epiphysis, but three patients (9%; 95% CI, 0%-19%) had local recurrence in the soft tissue. The limb survival rate was 97% (95% CI, 89%-100%) at 5 and 10 years. Complications treated with additional surgical procedures were recorded for 19 patients (54%), including three local recurrences, two infections, 11 fractures, and three nonunions. In 10 of these 19 patients, the allograft was removed. Only five of the total 35 study patients (14%) lost the originally preserved epiphysis owing to complications. The mean functional score was 26 points (range, 10-30 points, with a higher score representing a better result) at final followup.

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“…No joint replacement can function as well as the normal knee. Recently, a few series in which the epiphysis has been salvaged have been reported [7][8][9].…”

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confidence: 99%

Functional outcome in patients with osteosarcoma around the knee joint treated by minimised surgery

Hayashi

Tsuchiya

Yamamoto

et al. 2007

International Orthopaedics (SICO

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The functional results of prostheses and osteoarticular grafts for osteosarcoma around the knee joint are not satisfactory because of poor durability and gross distortion of the normal anatomy. We have investigated the functional outcome of intentional marginal excision for osteosarcoma around the knee joint in conjunction with caffeine-potentiated chemotherapy. Twenty-one patients with AJCC stage IIB high-grade osteosarcoma around the knee joint were given three to five preoperative courses of intra-arterial cisplatin and caffeine with or without doxorubicin. The histological response in these 21 patients to preoperative chemotherapy was grade IV (no viable cells) in 19 patients and grade III (only scattered foci of viable cells) in 2. The patients were separated into three groups on the basis of patterns of tumour excision. The first group underwent marginal excision of the proximal fibula, the second underwent epiphysis preservation followed by distraction osteogenesis, and the third underwent joint resection and reconstruction. The mean functional evaluations were 100, 95, and 88%, respectively. No local tumour recurrence was seen at mean follow-up of 97 months. Marginal excision of the proximal fibula resulted in excellent function. Preservation of the epiphysis leads to better function than joint resection.

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Classifying the location of osteosarcoma with reference to the epiphyseal plate helps determine the optimal skeletal resection in limb salvage procedures

Cited by 45 publications

References 1 publication

Joint-preserving Tumor Resection and Reconstruction Using Image-guided Computer Navigation

Joint-preserving Tumor Resection and Reconstruction Using Image-guided Computer Navigation

Survival, Recurrence, and Function After Epiphyseal Preservation and Allograft Reconstruction in Osteosarcoma of the Knee

Functional outcome in patients with osteosarcoma around the knee joint treated by minimised surgery

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