Impact of Level of Surgery on the Functional Outcomes in Patients with Lower Extremity Bone Tumors Undergoing Amputation Versus Limb Salvage Surgery.

Limb salvage surgery is the preferred treatment for bone tumors in the current surgical practice. The aim of this study was to compare the functional outcomes between amputation and limb salvage surgery based on the level of surgery at two levels: knee and hip. A single institutional analysis of 137 patients with lower extremity bone tumors was done between 2014 and 2020. Eighty-seven patients treated with amputation were compared with 50 patients treated with limb salvage surgery based on following variables: age, gender, histology, anatomic site, and MSTS score. The mean MSTS scores were fairly better in patients who underwent surgery at knee level compared to those who underwent surgery at hip level. The mean MSTS score at 1-year follow-up was 22.0 in amputation group compared to 22.4 in limb salvage group, whereas at 2-year follow-up was 24.1 in amputation group compared to 25.1 in limb salvage group. At knee level, functional outcomes were similar after amputation and limb salvage. At hip level, patients undergoing amputation had poorer MSTS scores compared to limb salvage surgery at 2-year follow-up (p = 0.04). The functional outcomes for patients undergoing surgery at knee level were similar irrespective of type of surgery. At longer follow-up, patients undergoing amputation at hip level had a poorer functional outcome compared to limb salvage surgery. Although limb salvage was associated with similar MSTS scores when compared with amputation, it produced a better functional outcome especially for proximally located tumors.

Prognostic Factors and Clinical Outcomes in Extraskeletal Ewing Sarcoma: A Cohort Study.

BACKGROUND: Extraskeletal Ewing sarcoma (ESE) is a lesser-known, rarer counterpart of Ewing sarcoma of bone. This single-center study sought to evaluate the prognosticators and outcomes following multimodality therapy in patients with ESE. METHODS: Forty-seven patients with ESE, treated between 2013 and 2018 with a standardized protocol and multimodality therapy using established doxorubicin-based regimens, were followed-up to assess outcomes. RESULTS: Median age at diagnosis was 20 (range 7-56) years, and 57.4% were male. Median tumor size was 7 (range 2-21) cm. The symptom-duration ranged from 1 to 8 (median 4) months. Tumor-site was trunkal in 61.7%, extremity in 23.4%, and head and neck 14.9%. Of the 35 patients with nonmetastatic disease at presentation, 13 underwent upfront surgery. The rest received chemotherapy followed by local treatment, which was surgical in 15 and radiotherapy in 5. At median follow-up of 24 (range 5-98) months, 55.3% patients had experienced events, and 29.8% had died of progressive disease. Three-year event-free survival was 41.1%, and overall survival was 53%. On univariate analysis, trunkal location, upfront surgery, and positive surgical margins were associated with inferior EFS. Trunkal tumors and upfront surgery were also associated with poorer OS. On multivariate analysis, trunkal location and margin-positive resections retained statistical significance for adverse EFS. CONCLUSIONS: Unless clearly resectable upfront, ESE should be downstaged with chemotherapy before local treatment. A margin-negative resection should be the objective when performing surgery. Definitive radiotherapy is an alternative in tumors not amenable for complete excision or when anticipated postoperative morbidity precludes radical surgery.

Factors Affecting Prognosis and Survival in Extremity Osteosarcoma.

BACKGROUND: Osteosarcoma is a malignant bone tumor affecting mainly children and young adults and commonly involves extremities. The aim of this study was to assess the patient-related, tumor-related, and treatment-related factors affecting the overall survival in patients with non-metastatic extremity osteosarcoma. METHODOLOGY: A retrospective, single institutional study of 100 patients with non-metastatic extremity osteosarcoma was done between 2014 and 2019. Age, sex, histologic type, tumor site, use of preoperative chemotherapy and its duration, response to chemotherapy, type of surgery, presence of local recurrence, occurrence of lung metastasis, and survival data were recorded. Survival analysis was done using Kaplan-Meier method. p < 0.05 by log-rank test was considered statistically significant. Statistical data were analyzed using SPSS v.25(IBM). RESULTS: The median age of presentation was 18 years with male sex preponderance. The most common site of presentation was distal femur, and commonest histological variant was osteoblastic osteosarcoma. Incidence of local recurrence was 9%, and lung metastasis was identified in 12% on follow-up. The 5-year overall survival (OS) was 65.5%, and 5-year local recurrence-free survival was 57.6%. The 5-year OS in neoadjuvant chemotherapy group was 80% compared to 39.5% in upfront surgery group (p = 0.015). The 5-year OS in patients with tumor necrosis > 90% and < 90% was 93.2% and 71.2%, respectively (p = 0.038). The 5-year OS in patients without lung metastasis was 76%, whereas none who developed lung metastasis has survived 5 years (p < 0.001). CONCLUSION: The use of neoadjuvant chemotherapy, good response to chemotherapy, and the absence of lung metastasis on follow-up can independently predict better overall survival.