Osteosarcoma - The outcomes of neoadjuvant chemotherapy and surgery

Objectives To describe an institutional experience of osteosarcoma of extremities and to determine whether neoadjuvant chemotherapy would allow limb salvage surgery yet maintain local disease control.Methods Between April 2011 to April 2013, 41 patients were seen in Department of Radiation Oncology with osteosarcoma. They were retrospectively analysed with respect to age, gender, site of tumor, stage, histology, surgery, post surgical histopathology response and condition on last follow up.Results There were 19 males and 8 females with age ranging from 16 yrs to 60 yrs. The most common site was around the knee joint (distal femur) and uncommon sites were pelvis, L3, scalp and gingiva. The commonest histology was high grade osteosarcoma. 14 patients were excluded from the study as they had no treatment or had metastatic disease. Out of the other 27 patients who were included in the study, 5 had amputation, 18 underwent limb salvage surgery and 4 had wide local excision. The follow up ranged from 3 to 27 months.7 patients were disease free at the last follow up and 9 patients developed metastases. 1 patient was found to have local recurrence during follow up. The sites of metastases seen were lung, bone, inguinal nodes and right ventricle.Conclusion The combination of advances in surgical techniques, improved imaging modalities to accurately document tumor extent and the effect of neoadjuvant chemotherapy has made limb salvage surgery as the standard of care in the management of osteosarcoma. Comprehensive multidisciplinary approach has transformed it from a disease with a modest long term survival in which at least 23 of the patients will be cured. Successful management of osteosarcoma with limb salvage surgery is a challenging problem in the developing world.