Clinical Outcome of Parosteal Osteosarcoma

Abstract

IntroductionParosteal osteosarcoma (POS), like periosteal, intracortical, and highgrade surface osteosarcomas, is a type of surface osteosarcoma. [1][2][3] Of these, POS accounts for 65% of juxtacortical osteosarcomas and is frequently encountered as a low-grade lesion with a low propensity to metastasize and 5-and 10-year survival rates of 80-90%. [4][5][6] Treatment with a wide operative margin and reconstruction using a prosthesis has been advocated. 7,8) Furthermore, lobulated parosteal lesions may be of higher-grade, and radiological evidence of invasion into the medullary canal or the presence of a non-mineralized soft-tissue mass of larger than 1 cm3 may suggest a poor prognosis. 9-12)Although previous reports have addressed the importance of obtaining a wide surgical margin in the treatment of parosteal osteosarcoma, in the clinical setting, intralesional resection is possible. TwoOriginal Article J Korean Bone Joint Tumor Soc 2013; 19: 20-27 , and deliberate compromise of its surgical margin, due to its reported excellent survival and indolent growth after intralesional resection.In the largest series of POS conducted to date, the risk of recurrence after intralesional or marginal resection was found to be significant. 6,7,13) However, the surgical management of locally recurrent POS and its clinical course after tumor recurrence has not been welldefined.Our primary study goal was to evaluate correlations between clinicopathologic findings and oncologic outcomes, and our secondary goal was to ascertain the fate of patients after treatment for local recurrence. Materials and MethodsWe retrospectively reviewed the records of 30 parosteal osteosarcoma (POS) patients treated between 1990 and 2010. However, we excluded 8 of the 30 for; incomplete data (2 patients), no surgery (2 patients), and a follow-up period of less than 2 years (4 patients).Therefore, the final study population consisted of 22 patients ( Purpose: The purpose of this study was to evaluate the oncologic outcomes of parosteal osteosarcoma (POS) and to ascertain the fates of patients after local recurrence (LR). Materials and Methods:The authors retrospectively reviewed 22 POS patients with an average follow-up of 114 months (range: 36-235 months). Seven of the 22 patients were referred after LR. There were 17 Stage IB and 5 Stage IIB (G2, 2; dedifferentiation, 3). Tumors were located in the femur (11) and in other locations (11). Initial surgical margins were wide in 10, marginal in 5, and intralesional in 7. Correlations between clinico-pathologic variables and LR and clinical courses after LR were evaluated. Results:The 10-year overall survival rate was 85.7%. Three (14%) patients developed distant metastasis and all of them succumbed to the disease. Nine (41%) patients developed LR. Tumor location, resection type, and surgical margin were found to be correlated with LR. At final follow-up, 7 of the 9 patients that experienced local failure achieved no evidence of disease. Conclusion: A substantial risk of misdiagnosis exists, especial...

Surface osteosarcomas: Diagnosis, treatment and outcome

“…retrospectively reviewed the results of 22 parosteal osteosarcoma patients treated by hemicortical excision and reconstruction. 13 The 10-year overall survival was 85.7% with an event free survival of 54.5%. Seven of their patients underwent intralesional excision due to mis-diagnosis and all of them developed local recurrence.…”

“…Song et al . retrospectively reviewed the results of 22 parosteal osteosarcoma patients treated by hemicortical excision and reconstruction 13. The 10-year overall survival was 85.7% with an event free survival of 54.5%.…”

“…reviewed the records of 22 parosteal osteosarcoma patients and none of them had metastatic disease at presentation. 13 In a series of 63 cases of parosteal osteosarcoma treated between 1978 and 2007, Zaikova et al . reported 9 (14.3%) patients developing metastases at a median of 22 months (6-123 months).…”