Cover Image

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.



Full Text:



Simon MA, Aschliman MA, Thomas N, Mankin HJ. Limb-Salvage Treatment Versus Amputation for Osteosarcoma of the Distal End of the Femur. J Bone Joint Surg Am. 2005 Dec 1;87(12): 2822–2822.

Bacci G, Ferrari S, Lari S, Mercuri M, Donati D, Longhi A, et al. Osteosarcoma of the limb amputation or limb salvage in patients treated by neoadjuvant chemotherapy. J Bone Joint Surg Br. 2002 Jan 1;84-B(1):88–92.

Osteosarcoma: Johns Hopkins Sidney Kimmel Comprehensive Cancer Center [Internet]. [cited 2014 Jan 18]. Available from:

Whelan JS, Jinks RC, McTiernan A, Sydes MR, Hook JM, Trani L, et al. Survival from highgrade localised extremity osteosarcoma: combined results and prognostic factors from three European Osteosarcoma Intergroup randomised controlled trials. Ann Oncol. 2012 Jun;23(6):1607–16.

Bandyopadhyay R. Role of Neo-Adjuvant Chemotherapy in the Treatment of Osteosarcoma. Open Journal of Orthopedics. 2012;02(02):25–9.

Souhami RL, Craft AW, Van der Eijken JW, Nooij M, Spooner D, Bramwell VH, et al. Randomised trial of two regimens of chemotherapy in operable osteosarcoma: a study of the European Osteosarcoma Intergroup. The Lancet. 1997 Sep;350(9082):911–7.

Zhang Q, Niu X, Cai Y, Hao L, Ding Y. [Prognostic factors for the local recurrence of osteosarcoma in extremities treated with combined therapy]. Zhonghua Wai Ke Za Zhi. 2007 Aug 15;45(16):1114–7.

Schwarz R, Bruland O, Cassoni A, Schomberg P, Bielack S. The role of radiotherapy in oseosarcoma. Cancer Treat. Res. 2009;152:147–64.

Kager L, Zoubek A, Pötschger U, Kastner U, Flege S, Kempf-Bielack B, et al. Primary Metastatic Osteosarcoma: Presentation and Outcome of Patients Treated on Neoadjuvant Cooperative Osteosarcoma Study Group Protocols. JCO. 2003 May 15;21(10):2011–


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

An initiative of The Tamil Nadu Dr M.G.R. Medical University