Pathological Fracture in Osteosarcoma: Is it Always an Indication for Amputation?

Malagelada, Francesc; Tarragó, L. Trullols; Tibrewal, Saket; Ibañez, A. Peiró; Jeyaseelan, Luckshmana; Alegria, Isidre Gracia

doi:10.5604/15093492.1097490

Cited by 6 publications

(8 citation statements)

References 32 publications

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“…They attributed this to tumor dissemination. However, other investigators reported no decrease in overall survival in pathologic fracture patients . Our results agree with the latter studies.…”

Section: Discussionsupporting

confidence: 93%

“…However, other investigators reported no decrease in overall survival in pathologic fracture patients. 7,16,21,24,25 Our results agree with the latter studies. There was no significant difference between the final outcomes in patients with a pathologic fracture and those without.…”

Section: Discussionsupporting

confidence: 92%

“…Kim et al. reported that the presence of a pathologic fracture has no prognostic relevance in patients with localized OS . Xie et al.…”

Section: Discussionmentioning

confidence: 99%

“…Kim et al reported that the presence of a pathologic fracture has no prognostic relevance in patients with localized OS. 25 Xie et al concluded that limb salvage surgery could be used in patients with pathologic fracture without significantly increasing risk of distant metastasis. 7 Our results must be interpreted recognizing the limitations to this study.…”

Section: Discussionmentioning

confidence: 99%

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Pathologic fracture in childhood and adolescent osteosarcoma: A single-institution experience

Haynes

Kaste

Ness

et al. 2016

Pediatr Blood Cancer

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Purpose Pathologic fractures occur in 5-10% of pediatric osteosarcoma cases and have historically been considered a contraindication to limb salvage. We purposed to describe the radiographic features of pathologic fracture and examine its impact on local recurrence rates, functional outcomes and overall survival. Methods We retrospectively analyzed patients at our institution from 1990-2015 with pathologic fracture at diagnosis or during neoadjuvant chemotherapy. We selected a control group of 50 osteosarcoma patients of similar age and gender without pathologic fracture from 1990-2015. Functional outcomes were scored using Musculoskeletal Tumor Society (MSTS) criteria. Chi square test was used for comparative analysis of groups. Results Thirty-six patients with 37 pathologic fractures form the study cohort. Of patients who received surgery, 18/34 patients with fracture underwent amputation, compared to 8/48 in the non-fracture group (p=0.007). Indications for amputation in fracture patients were tumor size (n=7), neurovascular involvement (n=6), and tumor progression during neoadjuvant chemotherapy (n=5). Only one patient (2.9%) in the fracture group who underwent limb salvage suffered local recurrence. Of patients who received neoadjuvant chemotherapy, 25/34 fracture patients showed poor histological response, compared to 24/47 non-fracture patients. (p=0.044) There was no statistically significant difference in overall survival between the two groups (p=0.96). Functional outcomes were significantly lower in fracture patients (median=17.5) than non-fracture patients (median=24) (p=0.023). Conclusions Radiographic features of pathologic fractures were highly variable in this population. Limb salvage surgery can be performed without increased risk of local recurrence. Patients with pathologic fracture suffer worse functional outcomes, but show no decrease in overall survival.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

“…Kim et al. reported that the presence of a pathologic fracture has no prognostic relevance in patients with localized OS . Xie et al.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Pathologic fracture in childhood and adolescent osteosarcoma: A single-institution experience

Haynes

Kaste

Ness

et al. 2016

Pediatr Blood Cancer

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“…Twenty-four articles were assessed for eligibility criteria. Twenty-one studies met our eligibility criteria and were finally included in our meta-analysis [1, 3, 4, 6-9, 13-16, 19, 22, 24-26, 29-32, 34].…”

Section: Methodsmentioning

confidence: 99%

Are Pathologic Fractures in Patients With Osteosarcoma Associated With Worse Survival Outcomes? A Systematic Review and Meta-analysis

Gonzalez

Bedi

Karczewski

et al. 2023

Clin Orthop Relat Res

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Background Pathologic fractures occur in 5% to 10% of patients with osteosarcoma, and prior studies have suggested they are prognostically important. However, because they represent an uncommon event in the setting of an already rare disease, most studies fail to reach conclusive findings, and there is no agreement about how best to treat pathologic fractures. Questions/purposes (1) Is the occurrence of a pathologic fracture in patients with osteosarcoma associated with poorer overall survivorship? (2) Is the occurrence of a pathologic fracture in patients with osteosarcoma associated with poorer local recurrence-free survival or metastasis-free survival? (3) Is the surgical approach (amputation or limb salvage) associated with differences in local recurrence rates in patients with osteosarcoma with pathologic fractures? Methods This systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Our study was registered in PROSPERO (ID: 380459). A search of the PubMed and Embase databases resulted in 625 and 747 titles, respectively. After application of the inclusion and exclusion criteria, 21 articles were finally included. Quality assessment of all studies was performed using the Newcastle-Ottawa Quality Assessment Scale. The Risk of Bias In Non-Randomized Studies of Interventions tool was used in the 11 articles that evaluated the effect of an intervention (amputation or limb salvage) on local recurrence rates. The relative risk (RR) was calculated to compare outcomes in patients with osteosarcoma with pathologic fractures and those without. Heterogeneity among studies was calculated using the I 2 statistic. The pooled RR was calculated using the fixed-effects or random-effects model depending on study heterogeneity. The fragility index and the ratio between the fragility index and the total number of participants for each outcome was additionally calculated to assess the robustness of our results. A total of 7604 patients with osteosarcoma, 12% of whom (885) had pathologic fractures, were included in our analysis. Results Pathologic fractures in patients with osteosarcoma were associated with lower 3-year (RR 1.53 [95% CI 1.29 to 1.82]; p < 0.001) and 5-year overall survival (RR 1.27 [95% CI 1.16 to 1.40]; p < 0.001). No difference in recurrence rates was found between patients with osteosarcoma with pathologic fractures and those without (RR 1.22 [95% CI 0.91 to 1.64]; p = 0.18). However, having a pathologic fracture was Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

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Limb salvage for treating pathological fracture at diagnosis in children and adolescents with localized high grade osteosarcoma

Salang

Foocharoen

Laopaiboon

et al. 2016

Cochrane Database of Systematic Reviews

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Pathological Fracture in Osteosarcoma: Is it Always an Indication for Amputation?

Abstract: 1. A pathologic fracture in an OS is not always a contraindication for limb salvage because the oncologic results are acceptable. 2. In selected cases limb salvage has similar success rates to amputation.

Cited by 6 publications

References 32 publications

Pathologic fracture in childhood and adolescent osteosarcoma: A single-institution experience

Pathologic fracture in childhood and adolescent osteosarcoma: A single-institution experience

Are Pathologic Fractures in Patients With Osteosarcoma Associated With Worse Survival Outcomes? A Systematic Review and Meta-analysis

Limb salvage for treating pathological fracture at diagnosis in children and adolescents with localized high grade osteosarcoma

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