Factors associated with local recurrence in operated osteosarcomas: A retrospective evaluation of 95 cases from a tertiary care center in a resource challenged environment

Poudel, Rishi Ram; Tiwari, Vivek; Kumar, Venkatesan Sampath; Bakhshi, Sameer; Gamanagatti, Shivanand; Khan, Shah Alam; Rastogi, Shishir

doi:10.1002/jso.24602

Cited by 16 publications

(12 citation statements)

References 33 publications

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“…Biopsy/tumor resection performed by different centers in this study is a significant predictor of the development of local recurrence and poorer overall survival. This is similar to the reports by Picci et al [66], Andreou et al [6], and Poudel et al [39]. The biopsy approach must be planned so that it can be completely and widely excised at the moment of the resection.…”

Section: Discussionsupporting

confidence: 86%

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Treatment-Related Prognostic Factors in Managing Osteosarcoma around the Knee with Limb Salvage Surgery: A Lesson from a Long-Term Follow-Up Study

Zhang

Zhu

et al. 2019

BioMed Research International

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Purpose. The aim of this study was to assess the treatment-related factors associated with local recurrence and overall survival of patients with osteosarcoma treated with limb-salvage surgery. Patients and Methods. Treatment-related factors were analyzed to evaluate their effects on local recurrence-free survival (LRFS) and overall survival (OS) in 182 patients from 2004 to 2013. Results. The mean length of follow-up was 73.4 ± 34.7 months (median, 68 months; range, 12-173 months), and 63 patients died by the end of the follow-up. The 5-year and 10-year overall survival rates were 68.6 ± 6.6% and 59.4 ± 10.6%, respectively. Univariate analysis showed that treatment-related prognostic factors for overall survival were prolonged symptom intervals >=60 days, biopsy/tumor resection performed by different centers, previous medical history, incomplete preoperative chemotherapy (<8 weeks), and prolonged postoperative interval >21 days. In the multivariate analysis, biopsy/tumor resection performed by different centers, incomplete implementation of planned new adjuvant chemotherapy, and delayed resumption of postoperative chemotherapy (>21 days) were risk factors for poor prognosis; biopsy/tumor resection performed by different centers and tumor necrosis <90% were independent predictors of local recurrence. Conclusion. For localized osteosarcoma treated with limb-salvage surgery, it is necessary to optimize timely standard chemotherapy and to resume postoperative chemotherapy to improve survival rates. Biopsies should be performed at experienced institutions in cases of developing local recurrence.

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Section: Discussionsupporting

confidence: 86%

“…The incidence of local recurrence (LR) in this study was 13.7% (25/182), and the 5-year LR-free survival was 85.3 ± 5.3%. Our local recurrence rate of 13.7% is slightly higher than that presented in some reported data [6, 12, 37, 38], but these data are equal to data from a larger series report [2, 8, 39–41].…”

Section: Discussioncontrasting

confidence: 63%

Treatment-Related Prognostic Factors in Managing Osteosarcoma around the Knee with Limb Salvage Surgery: A Lesson from a Long-Term Follow-Up Study

Zhang

Zhu

et al. 2019

BioMed Research International

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“…*p = 0.009; †p = 0.025. treating patients with osteosarcoma. Although many authors have studied the prognostic factors for LRFS or OS in osteosarcoma, 1,8,9,[15][16][17][18][19][20][21][22]24,[31][32][33][34][35][36][37] there has been no study focusing specifically on the prognostic significance of the vascular proximity of the tumour. Previous studies have demonstrated that the most important predictive factors regarding LR were poor response to neoadjuvant chemotherapy and inadequate surgical margins, 21,22 and those regarding OS were age, tumour size, tumour location, response to neoadjuvant chemotherapy, and pathological fracture.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have demonstrated that the most important predictive factors regarding LR were poor response to neoadjuvant chemotherapy and inadequate surgical margins, 21,22 and those regarding OS were age, tumour size, tumour location, response to neoadjuvant chemotherapy, and pathological fracture. 8,[15][16][17][18][19][20]35 However, several discrepancies have been observed between the various cohorts studied 21,22,31,32,37 and Bramer et al 35 concluded that this might be explained by methodological issues. In our study, the most important prognostic factors for LRFS were the tumour's response to neoadjuvant chemotherapy and also the presence of vascular invasion.…”

Section: Discussionmentioning

confidence: 99%

Preoperative surgical risk stratification in osteosarcoma based on the proximity to the major vessels

Fujiwara

Medellin

Sambri

et al. 2019

The Bone & Joint Journal

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Aims The aim of this study was to determine the risk of local recurrence and survival in patients with osteosarcoma based on the proximity of the tumour to the major vessels. Patients and Methods A total of 226 patients with high-grade non-metastatic osteosarcoma in the limbs were investigated. Median age at diagnosis was 15 years (4 to 67) with the ratio of male to female patients being 1.5:1. The most common site of the tumour was the femur (n = 103) followed by tibia (n = 66). The vascular proximity was categorized based on the preoperative MRI after neoadjuvant chemotherapy into four types: type 1 > 5 mm; type 2 ≤ 5 mm, > 0 mm; type 3 attached; type 4 surrounded. Results Limb salvage rate based on the proximity type was 92%, 88%, 51%, and 0% for types 1 to 4, respectively, and the overall survival at five years was 82%, 77%, 57%, and 67%, respectively (p < 0.001). Local recurrence rate in patients with limb-salvage surgery was 7%, 8%, and 22% for the types 1 to 3, respectively (p = 0.041), and local recurrence at the perivascular area was observed in 1% and 4% for type 2 and 3, respectively. The mean microscopic margin to the major vessels was 6.9 mm, 3.0 mm, and 1.4 mm for types 1 to 3, respectively. In type 3, local recurrence-free survival with limb salvage was significantly poorer compared with amputation (p = 0.025), while the latter offered no overall survival benefit. In this group of patients, factors such as good response to chemotherapy or limited vascular attachment to less than half circumference or longitudinal 10 mm reduced the risk of local recurrence. Conclusion The proximity of osteosarcoma to major blood vessels is a poor prognostic factor for local control and survival. Amputation offers better local control for tumours attached to the blood vessels but does not improve survival. Limb salvage surgery offers similar local control if the tumour attachment to blood vessels is limited. Cite this article: Bone Joint J 2019;101-B:1024–1031.

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“…On the other hand, deferring surgery for a later date can significantly increase the risk of recurrence of these tumours. Poudel et al 10 had studied the risk factors associated with local recurrence of Osteosarcoma and had reported that each week delay in surgery after completion of neo‐adjuvant chemotherapy increases recurrence risk by 1.14 times. Also, at a mean follow‐up of 2.8 years, just 20% patients with recurrence were surviving as against 60% of survivors in the group without local recurrence.…”

Section: Discussionmentioning

confidence: 99%

Bone sarcoma surgery in times of COVID‐19 pandemic lockdown‐early experience from a tertiary centre in India

Kumar

Banjara

Thapa

et al. 2020

Journal of Surgical Oncology

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Background and Objectives Coronavirus disease 2019 (COVID‐19) lockdown has presented a unique challenge for sarcoma care. The purpose of this study is to evaluate the early results and feasibility of surgeries for bone sarcomas during the COVID‐19 lockdown. Methods Our prospectively collected orthopaedic oncological database was reviewed to include two groups of patients‐ those who underwent surgery in the immediate 4 weeks before lockdown (non‐lockdown group) and those operated in the first 4 weeks of lockdown (lockdown group). All patients were followed‐up clinically and telephonically to collect the outcome data. Results Out of the 91 patients who qualified for inclusion, fifty were classified into the non‐lockdown group while 41 patients formed the lockdown group. Both the groups were comparable with respect to baseline demographic parameters. However, during the lockdown period 37 patients (90%) had undergone a major surgical intervention as against 24 patients (48%) in the non‐lockdown group (P < .001). There was no significant difference in type of anaesthesia, median estimated blood loss and procedure duration. None of the patients/health care workers had evidence of severe acute respiratory syndrome‐coronavirus 2 infection at 15 days follow‐up. Conclusion Our study results suggest that appendicular bone tumours can be safely operated with adequate precautions during the lockdown period.

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Factors associated with local recurrence in operated osteosarcomas: A retrospective evaluation of 95 cases from a tertiary care center in a resource challenged environment

Abstract: Lack of financial resources and availability of few tertiary care centers dealing with musculoskeletal oncology in the developing countries, lead to overburden with a long waiting list for tumor surgery making the scenario different from the Western world.

Cited by 16 publications

References 33 publications

Treatment-Related Prognostic Factors in Managing Osteosarcoma around the Knee with Limb Salvage Surgery: A Lesson from a Long-Term Follow-Up Study

Treatment-Related Prognostic Factors in Managing Osteosarcoma around the Knee with Limb Salvage Surgery: A Lesson from a Long-Term Follow-Up Study

Preoperative surgical risk stratification in osteosarcoma based on the proximity to the major vessels

Bone sarcoma surgery in times of COVID‐19 pandemic lockdown‐early experience from a tertiary centre in India

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