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Low-Grade Central Osteosarcoma Treatment & Management

  • Author: Barnaby Dedmond, MD; Chief Editor: Harris Gellman, MD  more...
 
Updated: Nov 30, 2015
 

Medical Therapy

The use of radiation therapy or chemotherapy in the treatment of low-grade central osteosarcoma is controversial because neither has been proven to be beneficial.[23]

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Surgical Therapy

Wide excision, which may include amputation, is the treatment of choice for low-grade central osteosarcoma.[24, 8] The disease's recurrence rate after such treatment is negligible, while the recurrence rate following curettage or marginal excision is 80-100%. Of the tumors that recur, 15% are high-grade lesions.

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Preoperative Details

Surgical planning is based on the size and location of the lesion. With low-grade central osteosarcomas located in the extremities, the primary decision is whether limb salvage is possible or if amputation is necessary. The decision is based on the tumor's proximity to major neurovascular bundles or its invasion of them, as well as on whether it will be possible to adequately perform a wide excision without sacrificing two or more major compartments.

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Intraoperative Details

The gross appearance of a low-grade central osteosarcoma is that of dense fibrous tissue with variable amounts of bone. Enneking reported that tetracycline labeling may be useful in distinguishing the transition from healthy bone to tumor if this change is not visibly evident.[16]

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Postoperative Details

The most important factor that affects the morbidity and mortality of low-grade central osteosarcoma is determination of whether the margins of the surgical specimen are free of tumor on histologic examination.

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Follow-up

Monitoring for signs of a developing infection is vitally important. Prevention or early evacuation of hematomas is helpful in preserving locally rotated tissue flaps. Finally, attention should be turned to proper rehabilitation, which includes retraining of the patient so that functional use of an extremity can be restored after involved muscle groups have been resected.

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Complications

Surgical complications vary depending on the location of the tumor and the surrounding structures. The most frequent complications include the following:

  • Infection - If this complication develops at the site of a prosthesis used for limb salvage, eradication of the infection frequently requires removal of the prosthesis, and amputation is sometimes required.
  • Hematoma - This may cause failure of a locally rotated tissue flap.
  • Loosening of the endoprosthesis
  • Distant metastases
  • Local recurrence
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Outcome and Prognosis

The recurrence of low-grade central osteosarcoma and the survival rates of patients with the disease include the following:

  • Recurrence rate after wide excision - Less than 5%
  • Recurrence rate after intralesional curettage or marginal excision - 80-100%
  • Five-year disease-free survival rate - 90%
  • Ten-year disease-free survival rate - 85%

Of tumors that recur, 15% recur as high-grade osteosarcomas with prognoses similar to those associated with traditional osteosarcomas. Recurrences can be observed 6 months to 20 years after primary treatment.

Pulmonary metastases are rare, but they can occur 5-10 years after successful surgical excision of the primary tumor. Metastases are more common in recurrences, especially when the lesions recur as high-grade osteosarcomas.

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Future and Controversies

The most important factor in the adequate treatment of low-grade central osteosarcoma is accurate diagnosis. Because of variability in the radiographic and histologic appearance of this lesion, the participation of a team consisting of a radiologist, pathologist, and orthopedic surgeon, all specializing in musculoskeletal oncology, is important. With accurate, prompt diagnosis and adequate surgical treatment, a low-grade central osteosarcoma is a curable lesion with a favorable prognosis.

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Contributor Information and Disclosures
Author

Barnaby Dedmond, MD Orthopedic Traumatologist, Lexington Orthopedics, Lexington Medical Center

Barnaby Dedmond, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Coauthor(s)

John Eady, MD Chief of Orthopedic Surgery, Dorn Veterans Affairs Hospital

John Eady, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Timothy A Damron, MD David G Murray Endowed Professor, Department of Orthopedic Surgery, Professor, Orthopedic Oncology and Adult Reconstruction, Vice Chair, Department of Orthopedics, State University of New York Upstate Medical University at Syracuse

Timothy A Damron, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Society for Experimental Biology and Medicine, Orthopaedic Research Society, Children's Oncology Group, Musculoskeletal Tumor Society, American College of Surgeons, American Medical Association, Connective Tissue Oncology Society

Disclosure: Received research grant from: National Institutes of Health NIAMS; Orthopaedic Research and Education Foundation; Stryker; Cempra; Wright Medical<br/>Received income in an amount equal to or greater than $250 from: Stryker, Inc (Educational travel to Stryker sponsored meetings)<br/>Received royalty from Lippincott, Williams, and Wilkins for editing/writing textbook; Received grant/research funds from Genentech for clinical research; Received grant/research funds from Orthovita for clinical research; Received grant/research funds from National Institutes of Health for clinical research; Received royalty from UpToDate for update preparation author; Received grant/research funds from Wright Medical, Inc. for clinical research.

References
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Standard radiographs of a low-grade central osteosarcoma of the distal femur.
Magnetic resonance image (MRI) of low-grade central osteosarcoma of the distal femur.
Magnetic resonance image (MRI) of low-grade central osteosarcoma of the distal femur.
Magnetic resonance image (MRI) of low-grade central osteosarcoma of the distal femur.
Bone scan of a low-grade central osteosarcoma of the distal femur.
Photomicrograph of a low-grade central osteosarcoma (original magnification, X40). Courtesy of Dr Ronald Burns, Palmetto Richland Department of Pathology.
Photomicrograph of a low-grade central osteosarcoma (original magnification, X100). Courtesy of Dr Ronald Burns, Palmetto Richland Department of Pathology.
Photomicrograph of a low-grade central osteosarcoma (original magnification, X400). Courtesy of Dr Ronald Burns, Palmetto Richland Department of Pathology.
 
 
 
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