表面骨肉瘤

目的探讨表面骨肉瘤的组织类型、临床、病理及影像学特征。方法回顾性分析经病理证实的表面骨肉瘤19例,其中骨膜骨肉瘤4例,部位分别为胫骨干中上段(3例)和腓骨下段(1例);X线片及CT显示肿物位于骨旁,外缘不规则,可见放射状骨针影;镜下为低度或中度恶性软骨肉瘤样改变。高度恶性表面骨肉瘤2例,肿物均位于股骨内侧;X线片显示肿物以广泛基底附于患骨,混杂骨膜反应;镜下显示高度恶性,似髓内型。去分化骨旁骨肉瘤1例,肿物位于股骨下端;患者曾先后4次手术,术后病理显示高分化组织内出现低分化区。经典骨旁骨肉瘤12例,肿物75%位于股骨下端干骺端后部。结果骨膜骨肉瘤4例均行保肢手术,已无瘤生存1.1～6.5年。高度恶性表面骨肉瘤2例,其中1例拒绝手术,3个月后死于肺及肝转移;另1例应用大剂量化疗及保肢治疗,现已无瘤生存19个月。去分化骨旁骨肉瘤1例,行假体旁复发性肿瘤切除,现已无瘤生存6个月。经典骨旁骨肉瘤的初始治疗均为保肢手术,其中9例随访1.2～9.6年,除1例局部复发、1例死于肺转移外,另外7例均无瘤生存。结论表面骨肉瘤四种组织类型各具有特殊性,应区别对待。骨膜骨肉瘤及经典骨旁骨肉瘤应以局部广泛切除或瘤段切除为主,预后较好;去分化型和高度恶性表面骨肉瘤恶性程度较高,预后较差。保肢或截肢均应配合有     

单纯广泛切除肿瘤治疗低度恶性中心型成骨肉瘤——13例低度恶性中心型成骨肉瘤的诊治经验及文献回顾

[目的]低度恶性中心型成骨肉瘤是发生于骨髓腔的低度恶性成骨肉瘤,临床罕见。总结本中心收治的低度恶性中心型成骨肉瘤病例的诊治过程及经验。[方法]回顾本中心自1998年1月~2008年6月收治的13例低度恶性中心型成骨肉瘤。患者平均就诊年龄31岁。8例为初治病例,5例为外院手术后复发病例。后者中4例在外院行囊内手术,1例行边缘手术。Ⅰ期肿瘤11例,Ⅲ期肿瘤2例。Ⅰ期患者均首选肿瘤单纯广泛切除术。[结果]2例局部复发者术后病理分别为纤维肉瘤和恶性纤维组织细胞瘤。2例Ⅲ期患者转移灶术后病理均为低度恶性中心型成骨肉瘤。术后平均随访29个月。1例Ⅰ期肿瘤患者术后15个月出现肺转移,其接受综合治疗后已继续存活27个月。1例Ⅲ期患者术后26个月死亡,另1例术后随访6个月后失访。其余10例患者未发现局部复发、远处转移。保肢手术者,MSTS 93评分平均79%。[结论]低度恶性中心型成骨肉瘤患者多数只需要广泛切除、保肢治疗,无需化疗即可获得较长期的生存和较好的术后功能。手术切除边界不足依然是最终导致肿瘤复发的常见原因。长期随访是必要的。部分局部复发病灶可能表现为高度恶性肉瘤。少部分患者可能出现远处转移病灶,转移病灶病理可能依然表现为"高分化"。     

多中心成骨肉瘤的治疗

目的探讨多中心成骨肉瘤的治疗方法。方法1998年1月至2005年6月治疗多中心成骨肉瘤患者9例，男7例，女2例。9例患者的临床特征、影像学表现、病理学检查均证实多中心成骨肉瘤的诊断。其中6例患者初诊时即存在多发骨肉瘤病灶；3例初诊时为单一骨肉瘤病灶，而后分别在确诊6、8、11个月出现第二处骨肉瘤病灶。1例患者因经济原因放弃治疗，其余8例患者接受阿霉素60mg／m^2,顺铂100mg／m^2,氨甲蝶呤8-12g／m^2长春新碱1．4mg／m^2、异环磷酰胺12．5g／m^2化疗1周期。化疗后根据病灶数目、部位以及对化疗的反应等决定包括手术、化疗在内的进一步治疗方案。对病灶数目较少、病灶可广泛切除的患者，如果化疗反应好，则在化疗的基础上广泛切除肿瘤，手术原则同单发性骨肉瘤；如果全身病灶数目多、部分病灶位于中轴骨等不易广泛切除的部位，则根据病情采取适当的姑息手术。对上述化疗反应差的患者，应用三氧化二砷、紫杉醇、VP-16化疗。结果放弃治疗的1例患者于确诊5个月后死于肿瘤引起的全身衰竭，5例初诊存在多发骨肉瘤病灶的患者平均生存时间9．8个月，其中2例对化疗反应好且完成4周期以上化疗的患者平均生存时间为15个月，对化疗反应差以及未能完成化疗的3例患者平均生存时间仅为7．1个月。3例病灶不同时出现的多中心成骨肉瘤患者平均随访2年，2例带瘤生存，无肺转移；1例无瘤生存。结论多中心成骨肉瘤预后较差，经积极的化疗，能够延长患者生命，改善预后。     

骨血管源性恶性肿瘤的临床分析

目的 回顾性分析临床上少见的血管源性恶性骨肿瘤的诊断、治疗和临床疗效.方法 从1998年10月至2008年11月我科诊治7例骨血管源性恶性肿瘤患者,包括5例血管内皮瘤和2例血管肉瘤.男4例,女3例;年龄19～76岁,平均42.6岁.1例为多中心病变,6例为单中心.1例病变位于椎体,其余6例位于四肢骨.所有患者均以局部疼痛就诊,病变影像学表现均为溶骨性破坏.其中2例血管肉瘤伴有软组织包块.1例脊柱病变接受边缘切除和术后放疗,5例接受广泛切除重建或截肢术,未行放化疗,另外1例放弃治疗.所有患者均经病理学诊断确诊,平均随访40个月(1～89个月).结果 股骨上段血管肉瘤患者半盆截肢后于术后17个月死于肺和内脏多发转移.脊柱血管内皮瘤患者术后3年死于其他原因.胫骨上端血管内皮瘤患者术后6年出现局部软组织复发,予以再次完整切除.保守治疗的患者带瘤生存,其他3例患者均无瘤生存.结论 骨的血管源性恶性肿瘤临床少见,主要根据病理学检查确诊,同一解剖部位的多中心病灶对诊断有一定特异性.手术广泛切除为治疗四肢病变的主要手段,椎体病变瘤内刮除后可辅以术后放疗.血管肉瘤恶性程度高、预后差.     

人工全股骨关节置换治疗股骨骨肉瘤

目的探讨全股骨人工关节置换术治疗股骨骨肉瘤的适应证和并发症,评估术后功能结果。方法1996年10月至2002年10月,采用全股骨人工关节置换术治疗骨肉瘤患者17例,其中男性8例,女性9例,年龄12～34岁,平均16岁;发病部位于股骨上段1例,股骨下段6例,股骨干10例;ⅡB期患者12例,ⅢB期5例;病灶范围23～28cm,有跳跃灶3例,病理骨折2例;术前均行病灶活检,明确诊断。17例行术前化疗,15例术后化疗。手术经患肢外侧入路,人工全股骨假体置换。按照MSTS93系统检查肢体功能恢复情况。结果17例患者均获得随访,平均45个月（9～120个月）。3例患者术后6～14个月局部复发（占17．6％）。ⅡB期12例患者中,4例死于肺转移（占33％）;8例无瘤存活,存活时间50—120个月,平均75个月。ⅢB期5例,死亡5例,存活9—20个月,平均13个月。15例术后恢复行走,占88％,肢体功能恢复率40％～93％,平均74％。3例术后并发神经麻痹,2例术后髋关节脱位,无一例术后感染。结论全股骨人工关节置换术适用于股骨广泛受侵的恶性骨肿瘤患者,能有效恢复肢体功能;对于Ⅲ期患者,姑息性保肢治疗能有效地改善生活质量;人工全股骨关节的设计有待进一步改进。     

旋转成形术治疗儿童股骨远端骨肉瘤

目的评估旋转成形术治疗儿童股骨远端骨肉瘤的临床疗效。方法回顾性分析2014年3月—2016年6月采用旋转成形术治疗的10例股骨远端骨肉瘤患儿临床资料。男7例,女3例;年龄4～10岁,平均6.7岁。病理类型:骨母细胞型骨肉瘤4例,混合型骨肉瘤4例,软骨母细胞型骨肉瘤2例。Enneking分期均为ⅡB期。病程3.5～6.0个月,平均4.6个月。术后应用1993年美国骨与软组织肿瘤协会(MSTS93)评分、多伦多下肢功能量表(TESS)评分及膝关节活动度评估患肢功能,影像学检查评估肿瘤复发及转移情况。结果术后1例出现切口延期愈合,经换药后愈合;其余患儿切口均Ⅰ期愈合。10例患儿均获随访,随访时间24～72个月,平均52.6个月。随访期间均无局部复发;3例出现远处转移后死亡1例、无瘤生存1例、带瘤生存1例。2例术后2年足跟部出现胼胝和溃疡,均经处理后好转。骨连接端愈合时间2.5～5.0个月,平均3.5个月。术后4个月患儿均能独立行走。末次随访时,MSTS93评分为19～25分,平均22分;TESS评分为87～93分,平均90分。佩戴假肢后膝关节活动度伸0°～10°,平均5°;屈85°～95°,平均90.5°。结论对于保肢困难的股骨远端骨肉瘤患儿,采用旋转成形术治疗能有效保留患肢功能,改善生活质量,可以作为截肢的备选术式。     

含洛铂方案的新辅助化疗在骨肉瘤及尤因肉瘤中的疗效观察

背景：化疗是骨肉瘤及尤因肉瘤最主要的治疗手段之一,目前化疗疗效已进入平台期,选择低毒高效的化疗药物及方案是关键。目的：观察含洛铂（LBP）方案的新辅助化疗对骨肉瘤及尤因肉瘤的疗效及不良反应。方法：2011年10月至2012年10月收治经病理学检查确诊为原发恶性骨肿瘤患者22例,其中骨肉瘤13例,尤因肉瘤9例;男17例,女5例,年龄9～23岁,平均18.3岁;Enneking分期：ⅡA期3例,ⅡB期19例。给予LBP-多柔比星（AMD）方案交替异环磷酰胺（IFO）方案（LBP 30mg/m2,AMD 60mg/m2;IFO12g/m2;全身静脉给药）的新辅助化疗,后行保肢手术治疗。采用RECIST评价标准评价其疗效,并观察不良反应。结果：22例中完全缓解（CR）1例,部分缓解（PR）18例,疾病稳定（SD）3例,总有效率（RR）为86.4%。随访3～14个月,平均9.2个月,1例脊柱骨肉瘤患者术后5个月复发,其余患者未发现复发或转移征象。主要不良反应为限制性骨髓抑制,化疗间歇期患者恢复快,无明显肾功能异常及过敏反应。结论：骨肉瘤及尤因肉瘤接受含LBP方案的新辅助化疗的近期疗效满意,不良反应可耐受,值得进一步临床研究。     

Ⅲ期骨肉瘤的治疗

目的探讨Ⅲ期骨肉瘤的诊断、治疗和预后。方法分析1989年12月至2003年12月收治的23例Ⅲ期肢体骨肉瘤患者,男14例,女9例;年龄16～31岁,平均22.4岁。肺转移15例,骨转移7例(跳跃转移5例,骨肉瘤病2例),同时存在肺和骨转移1例。经术前化疗,并行原发肿瘤和转移病灶的切除手术。结果经术前化疗,1例就诊时肺部有1个结节的患者转移瘤消失,1例同时存在肺和骨转移者,切除原发病灶后,出现多处转移,不能行转移灶切除手术;2例骨肉瘤病者仅切除原发病灶;5例跳跃转移者中的2例,切除原发和跳跃转移病灶后,各出现1个肺转移灶。16例行开胸术,其中6例再次出现肺转移灶而行二次开胸术,3例患者二次开胸术后出现肺外转移而放弃治疗。原发病灶与转移病灶的肿瘤坏死率差异无统计学意义。随访5～168个月(平均74.6个月),无瘤生存9例,带瘤生存4例,死亡10例。Cox模型分析提示转移病灶的数目与预后相关(P<0.05)。肺转移与跳跃转移病灶的Kaplan-Meier生存曲线经log-rank检验,差异无统计学意义。结论新辅助化疗及原发病灶和转移灶的手术切除是Ⅲ期骨肉瘤治疗的有效方法,首次肺转移灶切除采用胸骨正中切口,转移瘤的数目与预后相关。     

不同新辅助化疗方案治疗骨肉瘤的临床观察

[目的]探讨不同化疗方案对骨肉瘤治疗疗效目的影响.[方法]回顾分析本院所治疗目的40例ⅡB期骨肉瘤.男18例,女22例;年龄5～40岁,平均16岁;发病部位:股骨下端19例、胫骨上端13例、肱骨上端3例、股骨上端2例、股骨干2例、腓骨上端1例.随机应用MMIA方案17例,DIA方案23例.治疗方式为活检病理明确诊断后行术前化疗2疗程,休息2周后手术,术后继续化疗6疗程.[结果]加例患者均获得随访,平随访58个月.随访期内死亡14例,另外有3例肺转移,现带瘤生存;局部复发5例.经对比分析不同化疗方案与化疗后肿瘤细胞坏死率、不良反应发生率无相关性.MMIA方案5年无瘤生存率为41.18%,DIA方案5年无瘤生存率为48.70%,两者间无统计学差异.[结论]MMIA方案和DIA方案所治疗目的骨肉瘤疗效无明显差异,鉴于DDP目的临床应用具有更好目的治疗依从性.因此DIA方案可以作为我国骨肉瘤目的常首选化疗方案.     

顺铂、异环磷酰胺与阿霉素联合化疗治疗骨肉瘤的疗效观察

背景：随着现代肿瘤理论及诊治手段的发展,骨肉瘤的治疗目的不能仅满足于生存率的提高,更要提高患者的生活质量。治疗原则已转变为在肿瘤根治、追求生存的同时更多关注功能维持和心理健康。目的：观察顺铂（DDP）、异环磷酰胺（IFO）与阿霉素（ADM）联合化疗（DIA方案）治疗原发性骨肉瘤的疗效及对患者心理行为及生存质量的影响。方法：2004年1月至2011年11月应用DIA方案治疗51例骨肉瘤患者,男32例,女19例;年龄6～51岁,平均18岁;ⅡB期48例,Ⅲ期3例。对所有患者进行随访,计算5年无瘤生存率,对长期生存患者参照MSTS93评分标准进行患肢功能评价,采用90项自觉症状自评量表（SCL-90）和中文版医学结局研究简明调查表（SF-36）进行心理行为与生存质量评估。结果：全部获得随访,截至2013年1月,随访时间为2～104个月,中位随访时间为32个月,5年无瘤生存患者31例,无瘤生存率为60.7%。33例（31例无瘤生存,2例带瘤生存）长期生存患者的MSTS93评分为14～29分,平均20.6分,优良率为75.8%;SCL-90量表中人际关系、躯体化、焦虑、恐怖得分均高于常模（P〈0.05）;SF-36量表显示患者活力、总体健康、生理功能得分均较低。结论：DIA方案治疗原发性骨肉瘤切实可行,可使患者获得较高的长期生存率,但对患者心理行为和生存质量产生一定影响,提示我们需要加强骨肉瘤患者的心理支持,提高患者生存质量。     

Oncological and functional outcome of periosteal osteosarcoma

Background:

Periosteal osteosarcoma is an uncommon variant of osteosarcoma which constitutes less than 2% of all osteosarcomas. Whereas adequate surgical excision remains the cornerstone of treatment, the role of chemotherapy in this tumor is still unclear. Existing literature contains very few single center studies on the outcomes for periosteal osteosarcomas and any additional information will help in better understanding of these uncommon lesions. This study aims to evaluate the oncologic and functional outcomes of treatment of periosteal osteosarcoma treated at our institute.

Materials and Methods:

A retrospective analysis of 18 cases of periosteal osteosarcoma treated between January 2001 and December 2010 was carried out. There were 12 males and 6 females. The mean age at presentation was 16.3 years (range 5-26 years). Tibia and femur were the most common sites (n = 8). 16 of 18 patients received chemotherapy, 16 had limb sparing resection, one had an amputation and one had rotationplasty. Of the 16 patients with limb salvage, conventional wide excision was done in 11 cases. In 5 cases tumor was excised with hemicortical excision. Of the 11 cases treated with wide excisions, 4 patients underwent an osteoarticular resection and in 7 patients a joint preserving segmental intercalary resection was done.

Results:

All patients were available for followup. Surgical margins were free in all patients. A good response to chemotherapy was seen in 4/11 cases and poor in 6/11 cases. In one case the histological response was not discernible due to predominant chondromyxoid nature of the tumor. The median followup was 61 months (range: 18-130 months). There were two local recurrences (11%) at 9 and 18 months postsurgery. Pulmonary metastasis subsequently occurred in 4 cases (22%). Fourteen patients are currently alive and continuously disease free. Disease free survival at 5 years was 77.8% and overall survival (OVS) was 83.3%. Patients without marrow involvement had a better OVS at 5 years when compared with patients with marrow involvement (90% vs. 75%) (P = 0.23).

Conclusion:

Surgical excision remains the mainstay of treatment. Intramedullary involvement may suggest aggressive disease biology. The role of chemotherapy is still debatable and multicenter studies are needed to provide guidelines.     

Extra-osseous osteosarcoma: a clinical and histopathological study of four cases.

Four cases of extra-osseous osteosarcoma were found among 242 cases recorded as osteosarcoma in the Swedish Cancer Registry during the years 1958 to 1968. The tumours occurred in middle-aged and elderly patients. Three of the tumours were situated in the proximal part of the thigh and one in the scapular region. Histopathologically, all tumours were subclassified as osteoblastic osteosarcomas. The patients were treated by primary local excision which in one case was followed by a radical en bloc excision of the entire tumour bed. All cases subjected to simple excision died of metastatic disease five to twenty-four months after diagnosis. The patient treated by en bloc excision is alive and apparently free from disease fourteen years after diagnosis.     

骨旁骨肉瘤的治疗

目的 探讨骨旁骨肉瘤外科切除边界、髓腔受累情况等与预后之间的关系,以提高治疗水平。方法 对1964年6月～2001年12月收治的骨旁骨肉瘤66例中资料完整的48例进行回顾性研究。患者年龄13—47岁,平均29．2岁。男性16例,女性32例。最好发部位为股骨远端(36例),其次为股骨干(6例),胫骨近端(2例)等。以原发肿瘤就诊的39例,外院术后复发就诊的9例。结果 随访时间从3个月～24年,平均5．2年。保肢治疗39例,其中行瘤段截除灭活再植术23例,瘤段截除人工关节置换术9例,瘤段截除异体半关节置换术4例,受累皮质局部切除术3例。截肢组9例。广泛切除组35例,边缘切除组13例。本院治疗后,局部复发8例,其中广泛切除组3例,边缘切除组5例。在复发的病例中,髓腔未受累组4例,髓腔受累组4例。发生肺转移6例,其中死亡4例,带瘤生存2例。应用Kaplan-Meier法计算五年生存率为85．8％。结论 安全的外科边界是骨旁骨肉瘤获得良好预后的保证。在广泛切除绝大部分肿瘤的基础上,于血管神经束部位行谨慎的边缘切除是合理的。反复的复发可能会使预后变差。当复发肿瘤包绕血管神经束或表现为软组织内多个散在结节,局部切除不能达到安全广泛的外科边界时,应行广泛边界的截肢术以挽救患者的生命。     

老年骨肉瘤10例治疗总结

目的探讨老年骨肉瘤（≥60岁）的临床特点和治疗效果。 方法回顾性分析2007年1月至2017年3月期间山东大学齐鲁医院骨科收治的≥60岁的骨肉瘤患者10例,女性8例,男性2例,年龄60~76岁,平均（66±6）岁,病变位于股骨5例、踝关节软组织1例、多中心1例、骨盆（Ⅲ区）1例、肱骨1例、距骨1例。确诊后行截肢术2例,截肢术结合化疗2例,广泛切除术1例,广泛切除术结合化疗3例,边缘切除结合放疗1例,单纯化疗1例。 结果10例患者中,4例就诊时病史已超过6个月,2例就诊时已出现肺转移,5例合并基础疾病,2例血清ALP水平升高（>125 U/L）。影像学方面,7例为混合型,1例为溶骨型,1例为成骨型,1例位于软组织。肿瘤组织类型方面,普通型骨肉瘤7例,骨旁骨肉瘤2例,髓内高分化性骨肉瘤1例。10例患者随访3.5~124个月,平均（40±37）个月。1例接受单纯化疗的肺转移患者于明确诊断后3.5个月死亡,另1例肺转移患者接受转移灶射频消融术,随访58个月带瘤生存,1例距骨骨肉瘤复发后行截肢术。其余7例均未出现肿瘤复发或远处转移。 结论老年骨肉瘤临床较为少见,具有不同于青少年骨肉瘤的临床特点和预后,应早期明确诊断,采取适合患者自身情况的治疗方法,以尽可能降低复发和转移的发生率,延长生存期。     

Multidrug chemotherapy in pulmonary treatment of osteosarcoma.

Forty-three patients with osteosarcoma were treated with amputation and adjuvant chemotherapy utilizing a four-drug combination of cyclophosphamide, vincristine, phenylalanine mustard, and adriamycin (CONPADRI-I regimen). Twenty-four patients (56 per cent) remained free of metastases twelve to sixty-one months after diagnosis. Ten of the twenty-four have been disease-free for more than three years. Another group of thirty patients was treated with amputation and a five-drug adjuvant chemotherapy program which included the administration of massive doses of methotrexate with citrovorum factor (COMPADRI-II regimen). Twenty of the thirty (67 per cent) remained free of metastases from twelve to twenty-six months after amputation (median, sixteen months). Two deaths related to methotrexate toxicity occurred. Late metastases developed in three patients (at sixteen, nineteen, and twenty-six months after operation) in the group treated with the COMPADRI-II regimen.     

Limb salvage procedures for children with osteosarcoma: an alternative to amputation

Amputation remains the standard surgical management for patients with osteosarcoma. However, in carefully selected patients, eradication of the primary tumor can be achieved by En-Bloc resection of the affected bone preserving both anatomical and functional status. Our criteria for limb salvage procedures are that patients must: (1) be age 12 years or older, (2) have no angiographic or clinical evidence of neurovascular involvement, (3) have low-grade osteosarcoma and/or good response to preoperative chemotherapy, and (4) be compliant. Between November 1980 and October 1982, 32 patients with osteosarcoma of an extremity were seen. Eight patients ranging in age from 13 to 21 years underwent limb salvage procedures. Five of these had Tikhoff-Linberg procedures for upper extremity lesions, two had En-Bloc resections for distal femur lesions, and one patient had a segmental arthrodesis for a distal tibial lesion. Of these eight patients, two had low-grade parosteal osteosarcoma. Follow-up ranged from 10 to 28 months (median 16 months). The two patients with parosteal osteosarcoma received no further therapy, while the other six patients received multiple agent chemotherapy. One patient died at 18 months with bilateral pulmonary disease. None have had local recurrences. Two of the eight patients had minor skin necrosis, requiring revision subsequently. Three patients have had transient nerve palsy. All have had good functional results. With careful selection of patients by rigid criteria, limb salvage procedures can be a viable alternative to amputation.     

血管扩张性骨肉瘤的诊治

目的 提高血管扩张性骨肉瘤的早期诊断水平,避免误诊或延误治疗。方法 对１９９１～１９９８年收治的１０例血管扩张性骨肉瘤患者的临床影像病理特征进行回顾总结。１０例患者中,男６例,女４例,平均年龄２３．４岁,病灶部位：骨干５例,其中股骨干２例,肱骨干３例;干骺端偏干侧３例,其中股骨上段１例,胫骨上段２例;骨端２例,其中股骨下端１例,胫骨下端１例,术前仅２例经切开活检诊断为血管扩张性骨肉瘤;术前化疗８例,行保肢手术３例,截肢７例,１０例患者均行术后化疗。结果 经６～７２个月（平均２８个胡访,６例肺转移,５例死亡,１例带瘤存活,余４例无瘤存活,均未出现局部复发。结论 对血管扩张性骨肉瘤应结合临床影像病理,早期明确诊断并施以正确治疗。     

Marginal resection for osteosarcoma with effective preoperative chemotherapy

Objective: To present the clinical results of marginal resection with effective preoperative chemotherapy for treatment of osteosarcoma. Methods: Thirty‐eight patients (20 male and 18 female, average age 17 years), underwent marginal resection after confirmation of effective preoperative chemotherapy between 1999 and 2008 and the results were analyzed retrospectively. The distal femur was involved in 22 cases, proximal tibia in 11, proximal humerus in 4, and proximal fibula in 1. Thirty‐seven patients were stage IIB and one IIIB. Twenty‐nine patients were treated with the DIA, and 9 with the MMIA protocol. Twenty‐one patients underwent tumor resection and bone allograft transplantation. The epiphysis was preserved in 9 patients, and not in the other 12. Eleven patients underwent tumor resection and prosthetic replacement, and 4 tumor resection with autograft implantation. One patient underwent tumor resection and allograft with preservation of the epiphysis; another underwent marginal tumor resection only. Results: All patients received effective preoperative chemotherapy. At a median follow‐up of 52 months, local recurrence had developed in one patient (2.6% local recurrence rate). Pulmonary metastases developed in 9 patients (23.7%). Five patients died of metastases, one died of intracranial hemorrhage due to thrombocytopenia caused by postoperative chemotherapy. The overall 2‐year survival rate was 87.3%, and event‐free survival rate 75.5%. The overall 5‐year survival rate was 74.7%, and event‐free survival rate 60.8%. Excellent to good function of affected limbs was achieved in 60.5%. Conclusions: With careful preoperative evaluation and effective preoperative chemotherapy marginal resection of osteosarcoma can produce good results. Marginal resection of osteosarcoma should be performed by an experienced surgeon who is familiar with the limb salvage rules for osteosarcoma.     

Surgical treatment for osteosarcoma

Fifty-three patients who had a high-grade osteosarcoma had either a limb-salvage resection or an amputation. They all received adjuvant therapy that consisted of administration of Adriamycin (doxorubicin) and whole-lung irradiation. At the time of follow-up, the surgical margin was assessed by examination of the surgical specimen. Each patient was followed for at least three years or until death. The data suggested that a wide surgical margin is adequate to control a primary osteosarcoma. When a wide surgical margin can be used and a functional limb can be salvaged, an amputation probably is not required.