Relationship of chemotherapy-induced necrosis and surgical margins to local recurrence in osteosarcoma.

Picci, Piero; Sangiorgi, Luca; Rougraff, Bruce T.; Neff, James R.; Casadei, Roberto; Campanacci, Mario

doi:10.1200/jco.1994.12.12.2699

Cited by 271 publications

(154 citation statements)

References 19 publications

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“…Interestingly, the only element that demonstrated a statistically significant correlation with overall survival, albeit only in univariate analysis, was fibrosis/hyalinization. Consistent with previous reports, 7,8,[14][15][16]36,37 posttreatment tumor viability was an important determinant of overall survival. However, in several studies, good histologic response, as defined by the extent of necrosis, did not translate into survival benefit.…”

Section: Discussionsupporting

confidence: 80%

Histopathologic Features of Prognostic Significance in High-Grade Osteosarcoma

Chui

Kandel²,

Wong³

et al. 2016

Archives of Pathology &Amp; Laboratory Medicine

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Context.-In osteosarcoma treated with neoadjuvant chemotherapy the extent of tumor necrosis on resection is considered an indicator of treatment response, and this has been shown to correlate with survival in most but not all studies.Objective.-To identify additional histologic variables of prognostic significance in high-grade osteosarcoma.Design.-Slides of pretreatment biopsy and primary postneoadjuvant chemotherapy resections from 165 patients with high-grade osteosarcoma were reviewed. Univariate (Kaplan-Meier) and multivariate (Cox regression) analyses were performed to identify clinical and histomorphologic attributes associated with overall survival.Results.-Univariate analyses confirmed the prognostic significance of metastatic status on presentation, primary tumor size, anatomic site, and histologic subtype. Additionally, the identification of lymphovascular invasion, 10% or more residual viable tumor, and 10 or more mitoses per 10 high-powered fields assessed in posttreatment resections were associated with poor survival, retaining significance in multivariate analyses. Based on results from multivariate analysis, we developed a prognostic index incorporating primary tumor size and site, and significant histologic features assessed on resection (ie, lymphovascular invasion status, mitotic rate, and extent of viable tumor). This scoring system segregates patients into 3 risk categories with significant differences in overall survival and retained significance in an independent validation set of 42 cases.Conclusions.-The integration of clinical and microscopic features improves prognostication of patients with osteosarcoma.

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Section: Discussionsupporting

confidence: 80%

Histopathologic Features of Prognostic Significance in High-Grade Osteosarcoma

Chui

Kandel²,

Wong³

et al. 2016

Archives of Pathology &Amp; Laboratory Medicine

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“…14 The results of the current study, although limited in numbers, are consistent with this idea. Two of the 3 patients with local recurrence had markedly poor chemotherapy responses of 50% and 70%, respectively.…”

Section: Discussionsupporting

confidence: 80%

Risk of local recurrence after deltoid‐sparing resection for osteosarcoma of the proximal humerus

Gupta¹,

Yasko²,

Lewis³

et al. 2009

Cancer

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BACKGROUND: The anatomy of the shoulder poses special challenges with regard to limb‐sparing surgery. Resection of the deltoid muscle is considered by some surgeons to be necessary to achieve adequate margins for osteosarcoma of the proximal humerus. However, this can compromise the functional results after reconstruction of the shoulder. The goal of the current study was to determine whether deltoid‐sparing resection can be safely performed for osteosarcoma of the proximal humerus. METHODS: Between 1978 and 2005, 23 consecutive patients with high‐grade nonmetastatic osteosarcoma of the proximal humerus underwent limb‐sparing surgery with preservation of the deltoid muscle. All patients received neoadjuvant chemotherapy followed by surgery and postoperative chemotherapy. The mean follow‐up was 90 months (range, 7 months‐279 months). RESULTS: The overall survival at 5 years was 77%. At the time of last follow‐up, 14 (61%) of 23 of patients were alive without evidence of disease. Three (13%) patients developed local recurrence. Two of these patients had poor responses to chemotherapy, with tumor necrosis of 50% and 70%. The third patient had a pathologic fracture of the humerus. Positive surgical margins were associated with local recurrence, and 2 of 4 patients with a positive surgical margin developed local recurrence (P = .01). CONCLUSIONS: Preservation of the deltoid muscle can be performed for carefully selected patients with osteosarcoma of the proximal humerus. Routine use of the procedure is not justified, because it may be associated with an elevated risk of recurrence. The risk of local recurrence appears to be related to positive surgical margins and possibly the percentage of tumor necrosis. Cancer 2009. © 2009 American Cancer Society.

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“…It may facilitate resection and reconstruction in patients with complex bone tumors [4,[16][17][18]. Inadequate resection margins are associated with higher risk of local tumor recurrence and poorer patient survival [12]. With the advent of effective chemotherapy and accurate MRI [8], the real extent of tumor in the bone is known and it may allow a joint-preserving tumor resection.…”

Section: Discussionmentioning

confidence: 99%

Joint-preserving Tumor Resection and Reconstruction Using Image-guided Computer Navigation

Wong

Kumta

2013

Clinical Orthopaedics &Amp; Related Research

100

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Background Joint-preserving surgery is performed in select patients with bone sarcomas of extremities and allows patients to retain the native joint with better joint function. However, recurrences may relate to achieving adequate margins and there is frequently little room for error in tumors close to the joint surface. Further, the tumor margin on preoperative CT and/or MR images is difficult to transpose to the actual extent of tumor in the bone in the operating room.Questions/purposes We therefore determined whether joint-preserving tumor surgery could be performed accurately under image-guided computer navigation and determined local recurrences, function, and complications. Methods We retrospectively studied eight patients with bone sarcoma of extremities treated surgically by navigation with fused CT-MR images. We assessed the accuracy of resection in six patients by comparing the cross sections at the resection plane with complementary prosthesis templates. Mean age was 17 years (range, 6-46 years). Minimum followup was 25 months (mean, 41 months; range, 25-60 months). Results The achieved resection was accurate, with a

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Relationship of chemotherapy-induced necrosis and surgical margins to local recurrence in osteosarcoma.

Abstract: Chemotherapy-induced tumor necrosis and surgical margins are important prognostic factors for local control of patients with osteosarcoma.

Cited by 271 publications

References 19 publications

Histopathologic Features of Prognostic Significance in High-Grade Osteosarcoma

Histopathologic Features of Prognostic Significance in High-Grade Osteosarcoma

Risk of local recurrence after deltoid‐sparing resection for osteosarcoma of the proximal humerus

Joint-preserving Tumor Resection and Reconstruction Using Image-guided Computer Navigation

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