Posters— Surgical Treatment of Sarcomas

PATHOLOGIC FRACTURES IN OSTEOSARCOMA

Saghieh SS, Lin PP, Weber KW, Jaffe N, Patel SR, Benjamin RS, Yasko AW (The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA 77030)

Introduction: The majority of patients with osteosarcoma can be treated with limb salvage surgery. However, those who present with a pathologic fracture may be at a higher risk for local recurrence and poorer survival.

Method: This is a retrospective study of 65 patients diagnosed with osteosarcoma associated with a pathologic fracture treated between 1981 and 1998. Medical records, pathology reports and radiologic studies were reviewed in all of these patients and prognostic variables evaluated for local recurrence and overall survival.

Results: There were thirty-seven males and twenty-eight females. Twenty-seven were younger than seventeen and thirteen older than forty-five. Fifty-two patients presented with localized and thirteen with metastatic disease. The distal femur was the most frequent site (40%) of involvement. Limb salvage surgery was performed for thirty-four patients (52%). Amputation was performed for thirty-one (48%). The overall survival for patients with localized disease was 62% at five years. From all variables studied for patient survival, only localized disease (versus metastatic disease) and favorable chemotherapy response (versus poor response) were positive prognostic factors. Twelve (18%) local recurrences developed, nine (26%) after limb salvage and three (9%) after amputation. Of the prognostic variables analyzed for local recurrence, none reached statistical significance. However, limb salvage surgery for patients with localized disease who had a prior non-oncologic surgery resulted in a high percentage of local failures [4/5 patients (80%)].

Conclusion: Overall survival in patients with osteosarcoma who sustain a pathologic fracture is not compromised, however, local control can be jeopardized especially in patients who undergo extensive non-oncologic surgery prior to diagnosis and who subsequently are treated with limb salvage surgery. Although local control of the tumor must be individualized, amputation may be the surgery of choice for this high-risk group.