Limb Salvage Surgery for Osteosarcoma

Abstract

Successful management of osteosarcoma with limb salvage surgery is a challenging problem in the developing world. We report our early results with low-cost chemotherapy (without methotrexate) and low-cost limb salvage surgery. We prospectively collected data for 135 patients with histologically proven high-grade osteosarcoma of the extremities given neoadjuvant chemotherapy and treated with limb salvage surgery between January 2000 and February 2004. A locally designed and fabricated stainless steel customized megaprosthesis was used in 78 patients. Disease status and function was evaluated at followup ranging from 24 to 72 months. Followup data were available for 120 of the 135 patients. There were eight infections, four prosthesis breakages and three loosenings. Eighteen patients had local recurrence; 17 of these patients also developed lung metastases. Seventy-three patients (61%) were disease-free at followup. The group of 34 patients with 100% necrosis had better disease-free survival (79%). According to a modified Enneking system, the average functional score was 25.5 of 30 (85%) for the lower extremity and 20 of 30 (66%) for the shoulder. Our preliminary results suggest osteosarcoma can be managed well in a developing country in a cost-effective way. Limb salvage surgery has now become the standard of care.

Revision of Broken Knee Megaprostheses: New Solution to Old Problems

“…We chose stainless steel as the material since it was easy to work with and would keep the implant cost low. Our early experience with these prostheses in limb salvage for osteosarcoma was reported in 2007 [1]. A lowcost but technically compromised implant is a reality in many developing countries and not well reported.…”

“…In the year 2000, with the help of a local implant manufacturer, we began fabricating a very low-cost megaprosthesis to kick-start our limb salvage program [1]. The initial design was primitive and simplistic, but it gradually evolved as we learned from our failures; we had many breakages of the implant.…”

Análisis de los costes de diagnóstico y tratamiento de los sarcomas de partes blandas en centros de referencia

“…En las cirugías de salvamento de la extremidad se considera que sus costes y los de una amputación son similares 10,11 , aunque mejore la integración social y autopercepción en las cirugías de salvamento 11,12 . No obstante, conviene considerar las verdaderas ventajas en calidad de vida y que ello justifique el coste en el que se incurre 13 .…”

Current concepts on the surgical and medical management of osteosarcoma

“…In industrialized countries, the incidence of amputation due to malignancy has decreased from 0.62 per 100,000 people in 1988 to 0.35 per 100,000 people in 1996 [57,58]. In a large multicenter study, Bielack et al reported that the use of ablative surgery (defined as amputations, disarticulations, and rotationplasties) decreased from 60.1% in the 1980s to 31.4% in the 1990s [59].…”