Background
The optimal management of locally recurrent pediatric osteosarcoma is not established, especially after prior limb-sparing surgery. We describe our experience in the management of these patients and identify prognostic indicators of post-recurrence survival.
Methods
We conducted a retrospective single-institution review of patients with locally recurrent osteosarcoma after limb-salvage surgery who were treated between October 1989 and January 2012. The management of each recurrence was evaluated, and patient, disease, and treatment factors were correlated with post-recurrence survival (PRS).
Results
Of 200 patients who underwent limb-sparing procedures, 18 (9%) had biopsy-proven local recurrence. Recurrences occurred in soft tissue in 15 patients (83.3%). Six patients (33.3%) were amenable to repeat limb-sparing surgery. Median time to local recurrence was 1.4 years (range, 0.6–10.4 years). Median PRS was 11.8 months (range, 3.7 months – 12.1 years). Post-recurrence survival was significantly associated with the length of resection margins, and was longer when recurrent tumors were resected with margins of ≥1 cm, compared to subcentimeter or positive margins (P=0.03). Median PRS was longer in patients who underwent amputations (2.44 years) than those who underwent repeat limb-sparing surgery (0.86 years), and in patients who had distant metastases resected (2.70 years) than those who did not (0.85 years); however, differences were not significant.
Conclusions
Local management of recurrent osteosarcoma in a previously reconstructed limb is highly individualized. A sufficiently wide resection is important for local control of recurrences, independent of the type of surgery. Maintaining control of distant metastases may also contribute to improved survival.