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Osteosarcoma of the Pelvis: Outcome Analysis of Surgical Treatment

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Clinical Orthopaedics and Related Research

Abstract

Risk factors to explain the poor survival of patients with osteosarcoma of the pelvis are poorly understood. Therefore, we attempted to identify factors affecting survival and development of local recurrence and metastasis. We retrospectively reviewed 43 patients who had high-grade pelvic tumors and were treated surgically. Twenty lesions were chondroblastic, 10 fibroblastic, 11 osteoblastic, and one each was giant cell-rich and small cell osteosarcomas. At a median of 3.5 years (range, 0.3–21 years) postoperatively, 13 patients were alive with no evidence of disease. The overall and disease-free 5-year survival rates were 38% and 29%, respectively, at 5 years. Anatomic location, tumor size, and margin predicted survival. Fifteen patients (35%) had local recurrence. The 5-year cumulative incidence of recurrence with death as a competing risk factor was 34%. Location in the ilium and size of the tumor predicted local recurrence. Twenty-one (49%) of 43 patients had metastases develop. The cumulative incidence of metastasis with death as a competing risk factor was 48% at 5 years. Six patients who presented with metastasis had a worse survival than patients who had no evidence of metastasis at presentation (2-year survival, 33% versus 76%). If distant metastasis is diagnosed subsequent to primary treatment, aggressive therapy may be justified.

Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Bielack SS, Kempf-Bielack B, Delling G, Exner GU, Flege S, Helmke K, Kotz R, Salzer-Kuntschik M, Werner M, Winkelmann W, Zoubek A, Jurgens H, Winkler K. Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol. 2002;20:776–790.

    Article  PubMed  Google Scholar 

  2. Bielack SS, Wulff B, Delling G, Gobel U, Kotz R, Ritter J, Winkler K. Osteosarcoma of the trunk treated by multimodal therapy: experience of the Cooperative Osteosarcoma study group (COSS). Med Pediatr Oncol. 1995;24:6–12.

    Article  PubMed  CAS  Google Scholar 

  3. Campanacci M, Ruggieri P. Osteosarcoma. Bull Hosp Jt Dis Orthop Inst. 1991;51:1–11.

    PubMed  CAS  Google Scholar 

  4. Donati D, Giacomini S, Gozzi E, Ferrari S, Sangiorgi L, Tienghi A, DeGroot H, Bertoni F, Bacchini P, Bacci G, Mercuri M. Osteosarcoma of the pelvis. Eur J Surg Oncol. 2004;30:332–340.

    Article  PubMed  CAS  Google Scholar 

  5. Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg Am. 1978;60:731–746.

    PubMed  CAS  Google Scholar 

  6. Fahey M, Spanier SS, Vander Griend RA. Osteosarcoma of the pelvis: a clinical and histopathological study of twenty-five patients. J Bone Joint Surg Am. 1992;74:321–330.

    PubMed  CAS  Google Scholar 

  7. Frassica FJ, Sim FH, Frassica DA, Wold LE. Survival and management considerations in postirradiation osteosarcoma and Paget’s osteosarcoma. Clin Orthop Relat Res. 1991;270:120–127.

    PubMed  Google Scholar 

  8. Fuchs B, Pritchard DJ. Etiology of osteosarcoma. Clin Orthop Relat Res. 2002;397:40–52.

    Article  PubMed  Google Scholar 

  9. Fuchs B, Yaszemski MJ, Sim FH. Combined posterior pelvis and lumbar spine resection for sarcoma. Clin Orthop Relat Res. 2002;397:12–18.

    Article  PubMed  Google Scholar 

  10. Gooley TA, Leisenring W, Crowley J, Storer BE. Estimation of failure probabilities in the presence of competing risks: new representations of old estimators. Stat Med. 1999;18:695–706.

    Article  PubMed  CAS  Google Scholar 

  11. Grimer RJ, Carter SR, Tillman RM, Spooner D, Mangham DC, Kabukcuoglu Y. Osteosarcoma of the pelvis. J Bone Joint Surg Br. 1999;81:796–802.

    Article  PubMed  CAS  Google Scholar 

  12. Ham SJ, Kroon HM, Koops HS, Hoekstra HJ. Osteosarcoma of the pelvis: oncological results of 40 patients registered by The Netherlands Committee on Bone Tumours. Eur J Surg Oncol. 2000;26:53–60.

    Article  PubMed  CAS  Google Scholar 

  13. Hayden JB, Hoang BH. Osteosarcoma: basic science and clinical implications. Orthop Clin North Am. 2006;37:1–7.

    Article  PubMed  Google Scholar 

  14. Hugate RR, Wilkins RM, Kelly CM, Madsen W, Hinshaw I, Camozzi AB. Intraarterial chemotherapy for extremity osteosarcoma and MFH in adults. Clin Orthop Relat Res. 2008;466:1292–1301.

    Article  PubMed  Google Scholar 

  15. Huth JF, Eckardt JJ, Pignatti G, Eilber FR. Resection of malignant bone tumors of the pelvic girdle without extremity amputation. Arch Surg. 1988;123:1121–1124.

    PubMed  CAS  Google Scholar 

  16. Inoue YZ, Frassica FJ, Sim FH, Unni KK, Petersen IA, McLeod RA. Clinicopathologic features and treatment of postirradiation sarcoma of bone and soft tissue. J Surg Oncol. 2000;75:42–50.

    Article  PubMed  CAS  Google Scholar 

  17. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481.

    Article  Google Scholar 

  18. Kawai A, Huvos AG, Meyers PA, Healey JH. Osteosarcoma of the pelvis: oncologic results of 40 patients. Clin Orthop Relat Res. 1998;348:196–207.

    Article  PubMed  Google Scholar 

  19. Lunn M, McNeil D. Applying Cox regression to competing risks. Biometrics. 1995;51:524–532.

    Article  PubMed  CAS  Google Scholar 

  20. Matsuo T, Sugita T, Sato K, Hotta T, Tsuchiya H, Shimose S, Kubo T, Ochi M. Clinical outcomes of 54 pelvic osteosarcomas registered by Japanese Musculoskeletal Oncology Group. Oncology. 2005;68:375–381.

    Article  PubMed  Google Scholar 

  21. Meyers PA, Gorlick R. Osteosarcoma. Pediatr Clin North Am. 1997;44:973–989.

    Article  PubMed  CAS  Google Scholar 

  22. O’Connor MI, Sim FH. Salvage of the limb in the treatment of malignant pelvic tumors. J Bone Joint Surg Am. 1989;71:481–494.

    PubMed  CAS  Google Scholar 

  23. Ozaki T, Flege S, Kevric M, Lindner N, Maas R, Delling G, Schwarz R, von Hochstetter AR, Salzer-Kuntschik M, Berdel WE, Jurgens H, Exner GU, Reichardt P, Mayer-Steinacker R, Ewerbeck V, Kotz R, Winkelmann W, Bielack SS. Osteosarcoma of the pelvis: experience of the Cooperative Osteosarcoma Study Group. J Clin Oncol. 2003;21:334–341.

    Article  PubMed  Google Scholar 

  24. Pollock BH, Krischer JP, Vietti TJ. Interval between symptom onset and diagnosis of pediatric solid tumors. J Pediatr. 1991;119:725–732.

    Article  PubMed  CAS  Google Scholar 

  25. Saab R, Rao BN, Rodriguez-Galindo C, Billups CA, Fortenberry TN, Daw NC. Osteosarcoma of the pelvis in children and young adults: the St Jude Children’s Research Hospital experience. Cancer. 2005;103:1468–1474.

    Article  PubMed  Google Scholar 

  26. Shin KH, Rougraff BT, Simon MA. Oncologic outcomes of primary bone sarcomas of the pelvis. Clin Orthop Relat Res. 1994;304:207–217.

    PubMed  Google Scholar 

  27. Taylor WF, Ivins JC, Dahlin DC, Edmonson JH, Pritchard DJ. Trends and variability in survival from osteosarcoma. Mayo Clin Proc. 1978;53:695–700.

    PubMed  CAS  Google Scholar 

  28. Wurtz LD, Peabody TD, Simon MA. Delay in the diagnosis and treatment of primary bone sarcoma of the pelvis. J Bone Joint Surg Am. 1999;81:317–325.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Orthopedic Oncology, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Bruno Fuchs MD, PhD

  2. Division of Orthopedic Oncology, Mayo Clinic, Rochester, MN, USA

    Nathan Hoekzema MD & Franklin H. Sim MD

  3. Department of Biostatistics, Mayo Clinic, Rochester, MN, USA

    Dirk R. Larson MS

  4. Department of Surgical Pathology, Mayo Clinic, Rochester, MN, USA

    Carrie Y. Inwards MD

Authors
  1. Bruno Fuchs MD, PhD
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  2. Nathan Hoekzema MD
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  3. Dirk R. Larson MS
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  4. Carrie Y. Inwards MD
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  5. Franklin H. Sim MD
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Corresponding author

Correspondence to Bruno Fuchs MD, PhD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Fuchs, B., Hoekzema, N., Larson, D.R. et al. Osteosarcoma of the Pelvis: Outcome Analysis of Surgical Treatment. Clin Orthop Relat Res 467, 510–518 (2009). https://doi.org/10.1007/s11999-008-0495-x

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  • DOI: https://doi.org/10.1007/s11999-008-0495-x

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