Long-term follow-up in adults with extremity osteosarcoma: comparison of different surgical procedures – single-center experience

Introduction
Osteosarcoma is the most common primary malignant bone tumor in adults and is usually located in long bones. Standard treatment consists of perioperative chemotherapy and radical surgical resection. In the case of the extremity location, the gold standard is limb-sparing surgery (LSS) using a variety of reconstructive techniques.

Aim of the study
To assess long-term results of adults patients treated for limb osteosarcoma in our referral center depending on the method of surgical treatment.

Material and methods
In our study, we analyzed 175 adult patients with localized disease (American Joint Committee on Cancer [AJCC] stage I–III) treated for extremity osteosarcoma at our institution between 2000 and 2017. The median observation time was 41 months (3–225 months). 111 patients were treated with LSS (80 patients had tumor resection followed by endoprosthetic reconstruction, 31 patients had local resection without reconstruction) and 64 patients underwent amputation.

Results
5-year overall survival (OS) and progression-free survival (PFS) in the study group were 62% and 52% and the life expectancy was on average 136 months. In the group of patients treated with LSS, 5-year OS and PFS were 66% and 59%, respectively, and life expectancy was 147 months, while in the group of patients undergoing amputation 5-year OS, PFS and life expectancy were 55%, 42% and 117 months.

Conclusions
The best results in the treatment of extremity osteosarcoma were achieved in a group of patients without distant metastases at the time of diagnosis, treated with perioperative chemotherapy and radical resection followed by endoprosthetic reconstruction.