Does amputation offer any survival benefit over limb salvage in osteosarcoma patients with poor chemonecrosis and close margins?

Reddy, Krishna; Wafa, Hazem; Gaston, Czar Louie; Grimer, R. J.; Abudu, A.; Jeys, Lee; Carter, S; Tillman, R. M.

doi:10.1302/0301-620x.97b1.33924

Cited by 68 publications

(77 citation statements)

References 31 publications

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“…In large two metaanalyses involving more than 1,300 patients, our observations were confirmed where also a worse prognosis was found in patients who underwent amputation [10][11][12]. However, He et al presented different data in his meta-analysis, in which he did not find a statistically significant difference in the 5-year OS and the incidence of local recurrence in patients treated with a salvaging procedure and amputation [13].…”

Section: Discussionsupporting

confidence: 72%

Long-term follow-up in adults with extremity osteosarcoma: comparison of different surgical procedures – single-center experience

Goryń

Szostakowski

Pieńkowski

et al. 2019

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Introduction: Osteosarcoma is the most common primary malignant bone tumor in adults and is usually located in long bones. Standard treatment consists of perioperative chemotherapy and radical surgical resection. In the case of the extremity location, the gold standard is limb-sparing surgery (LSS) using a variety of reconstructive techniques. Aim of the study: To assess long-term results of adults patients treated for limb osteosarcoma in our referral center depending on the method of surgical treatment. Material and methods: In our study, we analyzed 175 adult patients with localized disease (American Joint Committee on Cancer [AJCC] stage I-III) treated for extremity osteosarcoma at our institution between 2000 and 2017. The median observation time was 41 months (3-225 months). 111 patients were treated with LSS (80 patients had tumor resection followed by endoprosthetic reconstruction, 31 patients had local resection without reconstruction) and 64 patients underwent amputation. Results: 5-year overall survival (OS) and progression-free survival (PFS) in the study group were 62% and 52% and the life expectancy was on average 136 months. In the group of patients treated with LSS, 5-year OS and PFS were 66% and 59%, respectively, and life expectancy was 147 months, while in the group of patients undergoing amputation 5-year OS, PFS and life expectancy were 55%, 42% and 117 months. Conclusions: The best results in the treatment of extremity osteosarcoma were achieved in a group of patients without distant metastases at the time of diagnosis, treated with perioperative chemotherapy and radical resection followed by endoprosthetic reconstruction.

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Section: Discussionsupporting

confidence: 72%

Long-term follow-up in adults with extremity osteosarcoma: comparison of different surgical procedures – single-center experience

Goryń

Szostakowski

Pieńkowski

et al. 2019

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“…Published research shows that patients undergoing such treatment are characterized by a better total survival rate as compared with patients after amputation, not to mention reducing physical disability and its psychological effects that occur in patients undergoing such mutilating procedure [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Functional outcome of surgical treatment of adults with extremity osteosarcoma after megaprosthetic reconstruction—single-center experience

et al. 2019

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Background: Osteosarcoma is the most common primary malignant bone tumor in adults and is usually located in the long bones. Standard treatment consists of perioperative chemotherapy and radical surgical resection. Limbsparing surgery using a variety of reconstructive techniques remains the gold standard. Methods: In our study, we retrospectively analyzed 90 adult patients operated at our institution between 2000 and 2017 for extremity osteosarcoma that underwent limb-sparing reconstruction with the megaprosthesis. Sixty-one patients underwent resection and reconstruction of the distal femur, 9 patients-proximal femur, 7 patientsproximal tibia, 5 patients-total femoral resection and reconstruction, 5 patients-proximal humeral resection, and 3 patients-other types of resection with endoprosthetic reconstruction. The median follow-up time was 41 months, median overall survival was 86 months (3-225 months), and progression-free survival was 81 months (1-86 months). Functional assessment was made on 48 out of 56 living patients, after endoprosthetic reconstruction. The assessment was made according to MSTS functional scale. Results: In 14 cases (15%), the endoprosthesis had to be explanted, or amputation was performed for local recurrence or septic complication. Due to a mechanical failure of the implant, we had to perform a revision in 5 patients (5%). Eighteen out of 74 patients with endoprosthesis died of the disease. The median MSTS score was 84% (53-100%), and the best result of 85% was achieved in patients after distal femoral resection with endoprosthetic reconstruction. Conclusion: Careful planning of the treatment of patients with extremity osteosarcoma that is performed at the referral centers gives the possibility of long-term survival with a good and excellent functional result.

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“…In this study, although mice in the FGR with rVSV‐K group tended to survive for a longer period than those in the NGR groups, there were no significant differences statistically, and distant metastasis occurred in all groups. Reddy et al reported that no difference was observed in survival outcome between limb salvage surgery with local recurrence and initial amputation without local recurrence . Whether local recurrence correlates with survival outcome in osteosarcoma patients is still controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Local recurrence after adjuvant therapy is most resistant to treatment . Moreover, it is unclear whether local recurrence affects overall survival in addition to affecting adjuvant chemotherapy . Thus, it should be considered in the outcome of the surgical management of osteosarcoma.…”

mentioning

confidence: 99%

Novel Near‐Infrared Fluorescence‐Guided Surgery With Vesicular Stomatitis Virus for Complete Surgical Resection of Osteosarcomas in Mice

Sakuda¹,

Kubo²,

Johan³

et al. 2019

Journal Orthopaedic Research

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Attempts have been made to visualize tumor cells intraoperatively with fluorescence guidance. However, the clear demarcation and complete tumor resection have always been a challenging task. To address this, we have developed a novel fluorescence bioimaging system with vesicular stomatitis virus (VSV) incorporating Katushka, near-infrared fluorescent protein. VSV is tumor-specific owing to the deficiency of antiviral interferon signaling pathways in tumor cells. We aimed to evaluate the tumor specificity of the recombinant VSV-Katushka (rVSV-K) in osteosarcoma cells and to assess the feasibility of complete tumor resection by the rVSV-K fluorescence guidance. In in vitro experiments, mouse and human osteosarcoma cell lines and normal human mesenchymal stem cells were infected with rVSV-K and observed by fluorescence microscopy. Near-infrared fluorescence was observed only in osteosarcoma cells, even at a low-concentration of virus infections. In in vivo experiments, mouse osteosarcoma (LM8) cells were transplanted subcutaneously into the back of immune-competent mice to produce an osteosarcoma, which was then injected with rVSV-K. The areas emitting fluorescence were resected using a bioimaging system. The distance between the surgical and tumor margins of the fluorescence-guided resection with rVSV-K group was significantly larger than that of the non-guided resection groups. The local recurrence rate was significantly lower in the fluorescence-guided resection with rVSV-K group than in the non-guided resection groups. The distant metastasis rate and average survival rate were not significantly different between all groups. These results suggest that the rVSV-K is specific to osteosarcoma cells and enables complete tumor resection of osteosarcomas in mice. ß 2019 Orthopaedic

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Does amputation offer any survival benefit over limb salvage in osteosarcoma patients with poor chemonecrosis and close margins?

Cited by 68 publications

References 31 publications

Long-term follow-up in adults with extremity osteosarcoma: comparison of different surgical procedures – single-center experience

Long-term follow-up in adults with extremity osteosarcoma: comparison of different surgical procedures – single-center experience

Functional outcome of surgical treatment of adults with extremity osteosarcoma after megaprosthetic reconstruction—single-center experience

Novel Near‐Infrared Fluorescence‐Guided Surgery With Vesicular Stomatitis Virus for Complete Surgical Resection of Osteosarcomas in Mice

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