Abstract：Objective To analyze the curative effect of neoadjuvant chemotherapy combined with limb salvage for osteosarcoma with pathologic fracture. Methods The cases were divided into combined group (68 cases of osteosarcoma with pathologic fracture who received limb salvage after neoadjuvant chemotherapy), non-chemotherapy group (22 cases of osteosarcoma with pathologic fracture who received operation without concurrent chemotherapy or chemotherapy only after operation), non-fracture group (48 cases of osteosarcoma without synchronous pathologic fracture who received limb salvage after neoadjuvant chemotherapy) and amputation group (32 cases of osteosarcoma combined with pathologic fracture who received amputation). Survival rate, local recurrence rate, metastasis rate and quality of life were compared between groups. Results Average estimated survival period of the combined group was obviously longer than that of the non-chemotherapy group (P<0.05）, but had no significant difference from the non-fracture group or amputation group. Of the 5-year survival rate between groups, the combined group was evidently higher than the non-chemotherapy group （P<0.05）, but without significant difference from the non-fracture group or amputation group. Whereas, non-chemotherapy group showed a lower 5-year survival rate than the amputation group or non-fracture group （P<0.05）. Localized recurrence rate and metastasis rate of the combined group were markedly decreased when compared to the non-chemotherapy group （both P<0.01）, but were not significantly different from the non-fracture group or the amputation group. The combined group showed a significantly higher score of social function than the amputation group (P<0.01), a significantly higher score of biological profession than the non-chemotherapy group or the amputation group (P<0.05), and a significantly higher score of general health than the non-chemotherapy group （P<0.05）. However, no significant differences were observed between groups regarding the scores for other items. Conclusion New adjuvant chemotherapy combined with limb salvage is a rational treatment of osteosarcoma with pathologic fracture for it saves the limb after the guarantee of survival rate without increasing the localized recurrence rate or metastasis rate, and improves quality of life.
LUO Ren-feng,HE An-bing,CHEN Chun-zhou. New adjuvant chemotherapy combined with limb salvage for osteosarcoma combined with pathologic fracture[J]. CHINESE JOURNAL OF TRAUMA, 2013, 29(4): 334-337.
［1］Rosen G, Caparros B, Huvos AG, et al. Preoperative chemotherapy for osteogenic sarcoma: selection of postoperative adjuvant chemotherapy based on the response of the primary tumor to preoperative chemotherapy. Cancer, 2002, 49(6):1221-1230.
［2］Anninga JK, Gelderblom H, Fiocco M, et al. Chemotherapeutic adjuvant treatment for osteosarcoma: where do we stand? Eur J Cancer, 2011, 47(16):2431-2445.
［3］Bacci GB, Picci P, Ferrari S, et al. Primary chemotherapy and delayed surgery for nonmetastatic osteosarcoma of the extremities. Results in 164 patients preoperatively treated with high doses of methotrexate followed by cisplatin and doxorubicin. Cancer, 1993, 72(11):3227-3238.
［4］Kraybill WG, Harris J, Spiro IJ, et al. Long-term results of a phase 2 study of neoadjuvant chemotherapy and radiotherapy in the management of high-risk, high-grade, soft tissue sarcomas of the extremities and body wall. Cancer, 2010, 116(19):4613-4621.
［5］Scully SP, Ghert MA, Zurakowski D, et al. Pathologic fracture in osteosarcoma: prognostic importance and treatment implications. J Bone Joint Surg (Am), 2010, 84（1）:49-57.
［6］Furguson PC, McLaughlin CE, Griffin AM, et al. Clinical and functional outcomes of patients with a pathologic fracture in high-grade osteosarcoma. J Surg Oncol, 2010, 102(2):120-124.
［7］Kim MS, Lee SY, Lee TR, et al. Prognostic effect of pathologic fracture in localized osteosarcoma: a cohort/case controlled study at a single institute. J Surg Oncol, 2009, 100(3):233-239.
［8］Abudu A, Sferopoulos NK, Tillman RM, et al. The surgical treatment and outcome of pathological fractures in localised osteosarcoma. J Bone Joint Surg (Br), 1996, 78(5):694-698.
［9］Papagelopoulos PJ, Mavrogenis AF, Savvidou OD, et al. Pathological fracture in primary bone sarcomas. Injury, 2008, 39(4):395-403.
［10］Ottaviani G, Robert RS, Huh WW, et al. Functional, psychosocial and professional outcomes in long-term survivors of lower-extremity osteosarcomas: amputation versus limb salvage. Cancer TreatRes, 2009, 152:421-436.
