Surgical outcomes and prognostic factors of non-metastatic radiation-induced sarcoma of bone |
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| Institution: | 1. Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK;2. The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK;3. Aston University Medical School, Aston Express Way, Birmingham, B4 7ET, UK;4. Orthopaedic Department University Hospital of Tours, 37044, Cedex 9 Tours, France;5. Life & Health Sciences at University of Aston, Aston Expressway, Birmingham, B4 7ET, UK;1. Department of Plastic and Reconstructive Surgery, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama 700-8558, Japan;2. Division of Head and Neck Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan;1. The Royal Marsden Hospital, Fulham Rd, London, SW36JJ, UK;2. Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, Netherlands;3. The Institute of Cancer Research, 123 Old Brompton Rd, London, SW7 3RP, UK;4. Istituto Tumori, Via Giacomo Venezian, 20133, Milano, Italy;1. Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands;2. Department of Epidemiology and Biostatistics, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands;3. Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands;4. Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuuppin, Germany;5. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands;1. Dermatology Department, Hospital Universitari Germans Trial i Pujol, Institut d''investigació en ciències de la salut Germans Trias i Pujol. Badalona, Universitat Autònoma de Barcelona, Spain;2. Dermatology Department, Instituto Dermatológico GlobalDerm, Palma del Río, Córdoba, Spain;3. Medical Sciences Department, Section of Dermatology, University of Turin, Turin, Italy;4. Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d''investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain;5. Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras, Barcelona, Spain;6. Melanoma Unit, Medical-&-Surgical Dermatology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain;7. Section of Surgical Pathology, Medical Science Department, University of Turin, Italy;8. Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain;9. Pathology Department, Instituto Valenciano de Oncología, Valencia, Spain;10. Plastic Surgery Department, Hospital Universitari Germans Trial i Pujol. Badalona, Spain;11. Pathology Department, Hospital Universitari Germans Trial i Pujol. Badalona, Spain;1. Providence Health Care Breast Centre, Mount Saint Joseph Hospital, 3rd Floor, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada;2. University of British Columbia, Vancouver, British Columbia, Canada |
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| Abstract: | BackgroundThe survival and prognostic factors in non-metastatic, radiation-induced bone sarcomas of bone have not been described. Moreover, the quantitative data about surgical outcomes and complications after limb-salvage surgery versus amputation are quite limited.MethodsTwenty-five patients with non-metastatic, radiation-induced sarcoma of bone who underwent definitive surgery were analysed. Histological diagnosis was osteosarcoma in 19 and undifferentiated pleomorphic sarcoma in six. The definitive surgery was limb-salvage surgery in 15 patients and an amputation in 10.ResultsThe 5-year overall survival rate (OS) and the 5-year event-free survival rate (EFS) were 53% (95% CI 31%–70%) and 40% (21%–59%), respectively. Patients with wide or radical surgical margins (n = 13) showed significantly better OS compared with those with marginal (n = 8) or intralesional (n = 2) margins (5-year OS, radical or wide = 74%, marginal = 17%, intralesional = 0%, p = 0.044). The risk of local recurrence was significantly higher in the limb-salvage group compared to the amputation group (49% vs 0%, p = 0.011). OS and EFS were not significantly different between limb-salvage group and an amputation group (p = 0.188 and 0.912, respectively).ConclusionsWe believe non-metastatic, radiation-induced sarcoma of bone should be resected with the aim of achieving wide or radical margins. Although limb-salvage surgery was related to higher rates of local recurrence compared with those of the amputation group, OS and EFS were not different among two groups. Surgeons need to discuss the higher risk of local recurrence in limb-salvage surgery. |
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| Keywords: | Radiation-induced sarcoma of bone Surgical outcomes Prognosis |
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