JOURNAL READING

PREODITA AGRADI
 INTRODUCTION

Osteosarcoma most common orthopaedic

malignancy
Occurs in :
Distal Femur
Proximal Humerus Metaphysis of long
bones
Proximal Tibia
 INTRODUCTION

The age with peak incidence : 14-26 years old

Main clinical symptoms :
Pain
Lumps
Swelling
Dysfunction
Visible pathological fracture
Outcomes of osteosarcoma : poor, prone to metastasis
Goal of osteosarcoma treatment :
Control the primary tumor
Mantain optimal extremity function
Minimize treatment related adverse reactions
 INTRODUCTION

Limb salvage surgery

main way of treatment of limb osteosarcoma
Satisfying local control and short term efficacy
Limited long term efficacy
Aggressive polychemotherapy 5 year overall
survival rate 50-80%.
Neoadjuvant chemotherapy widely used in the
treatment of osteosarcoma
Reduce the boundaries of osteosarcoma
Eliminate the potential micrometastasis and prolong relapse
free survival period
Combination of neoadjuvant chemotherapy + limb
salvage surgery excellent outcome
 INTRODUCTION

Retrospective study aiming to :

Compare short term efficacy
Treatment-related adverse reactions
Long term survival between neoadjuvant chemotherapy
combined with limb salvage surgery and adjuvant
chemotherapy combined with limb salvage surgery
 PATIENT AND METHODS

PATIENTS
Inclusion criteria :
Histological diagnosis of limb osteosarcoma by biopsy
No distant metastasis confirmd by CT and radionuuclide
bone scan
Enneking stage IIA or IIB
Main neve, blood vessels are not involved
Patients without congenital disease
Patients without chemotherapy contraindications and
anesthetic allergy
 PATIENTS AND METHODS

From January 2010 to December 2013, total of 98

patients
Group A and Group B
Group A 56 patients received neoadjuvant
chemotherapy and limb salvage surgery
Group B 42 patients received adjuvant
chemotherapy and limb salvage surgery
Drugs :
Epirubicin, Cisplatin, Methotreaxate, Ifosfamide,
Calcium folinate, and Mesna
 PATIENTS AND METHODS

TREATMENT :
Neoadjuvant chemotherapy regimen
Cisplatin (95mg/m2) in day 1
+Epirubicin (85mg/m2) in day 1-3
+Methotrexate (10 g/m2) in day 4-10
+Ifosfamide (2 g/m2) in day 15-19
Adequate hydration and diuretics were given after
injection of cisplatin
After first injection of methotrexate, calcium folinate
was administered once in every 6 hours 14 times
Prevent cystitis mesa injection after ifosfamide
injection
 PATIENTS AND METHODS

SURGERY
Surgery was conducted 2 weeks followed by two
courses of neoadjuvant chemotherapy
Extensive resection of the capsule and at least 5 cm
from the surgical margin to the tumor
Limb reconstruction methods :
Tumor inactivation and bone re-implantation
Artifical knee arthroplasty
Artificial prosthesis replacement
Artificial hip arthroplasty
Post operative chemotherapy : 2 course
Patient group B : treated with limb salvage surgery and 6
cycles of adjuvant chemotherapy
 PATIENTS AND METHODS

The local recurrence and metastasis rate of 2

groups observed and recorded
Limb function after 6 months treatment was
assessed according MSTS93
Follow up :
Chest CT-scan case of metastasis
orthotopic and lateral xray of affected limb every 1 or 2
months for 1st-2nd year, every 3 months for 3rd year, and
every 6 months thereafter.
Statistical methods :
SPSS 18
 RESULTS

Patient Characteristics
Baseline characteristic no significant differences between
group A and group B
Significant difference in the type of reconstruction between
the two group (p<0.05)
Recurrence and Metastasis
Median follow up time : 59 months
During follow up period : 14 patients in group A and 20 patients
in group B treatment failure
In group A, 5 patients (pulmonary metastasis), 1 patients (bone
metastasis)
In group B, 6 patients (pulmonary metastasis), 2 patients (bone
metastasis)
Total metastasis and recurrence rate of group A was
significantly lower than that group B
RESULTS
 RESULTS

Survival Analysis
Group A : 13 patients died
Group B : 18 patients died
Mortality rates of group A were significantly lower than
those of group B
Progression free survival (PFS) and Overall survival (OS) of
group A were both significantly higher than those of group B
Adverse Reactions
There were no treatment related death
Limb funtions
Rate of limb function in group A was significantly higher
than that in group B
RESULTS
RESULTS
 DISCUSSION

Osteosarcoma :
Highly malignant systemic tumor
Died due to distant metastasis
 DISCUSSION

Past amputation

Present limb salvage surgery

 DISCUSSION

Combination of chemotherapy + surgery long

term survival for patients with osteosarcoma
increased from 10-15% to 65-70
Neoadjuvant therapy has many advantages :
Eliminate the satellite lesion
Shrink the primary lesion
Reduce the recurrence rate

First line chemotherapy for osteosarcoma treatment

: Epirubicin + Cisplatin + Methotrexate+ Ifosfamide
 CONCLUSION

This study demonstrated the excellent outcome of

neoadjuvant chemotherapy combined with limb
salvage surgery for the patients with limb
osteosarcoma of Enneking stage II

Limitation :
Retrospective study
Small sample size