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題 名 | Treatment of High-grade Primary Osteosarcoma in Extremities--15-year Clinical Experience in VGH-Taipei |
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作 者 | 陳威明; 陳天雄; 黃清貴; 林建甫; 施麗媛; 羅惠熙; | 書刊名 | 中華民國骨科醫學會雜誌 |
卷 期 | 17:1 2000.03[民89.03] |
頁 次 | 頁11-16 |
分類號 | 416.66 |
關鍵詞 | 骨肉瘤; Osteosarcoma; Extremities; |
語 文 | 英文(English) |
英文摘要 | From august 1983 to March 1997, 71 consecutive patients underwent surgery for high-grade primary osteosarcoma (1 IB, 56 IIB, and 14 IIIB) in extremities. There were 46 (65%) males and 25 (35%) females, whose mean age at the time of diagnosis was 17 years (range, 8-34). Most of the tumors were located in the distal femur (27 patients), proximal tibia (20 patients), and proximal humerus (10 patients). Totally, 22 (31%) patients underwent amputation surgery and 49 (69%) patients received wide exision and limb reconstruction. A variety of reconstruction methods were used, including tumor prosthesis replacement, extracorporeal irradiation and reimplantation, massive segmental allograft, allograft-prosthetic composite, vascularized or nonvascularized free fibular graft, and arthrodesis with metallic spacer. All of the patients except one had received adiuvant +/- neoadiuvant chemotherapy. Three patients were lost to follow up. Of the remaining 68 patients, 23 (34%) are alive with no evidence of disease at an average follow-up of 65 months (range, 26 to 187); 42 (62%) have died of disease, and 3 (4%) are alive with disease (lung metastases). 14 (21%) patients, including 12 with limb salvage surgery and 2 with ampuation, developed a local recurrence at an average of 17 months (range, 2 to 43) after having initial surgical treatment. Comparing with the amputation group, carried significantly higher local recurrence rate (p=0.0348), higher survival rate (p=0.025), and higher complication rate (p<0.001). Interestingly, in the limb salvage group, the patients with a routine magnetic resonance imaging examination showed higher local recurrence rate (p=0.174) than those without. As for pathological fracture or not, the anatomic location of the tumor, and the different reconstruction methods, none of them showed significant difference in the survival rate. The 2- and 5-year overall survival rates were 45% and 14% respectively for those treated prior to 1992: 77% and 50% for those treated after (p<0.05). Additionally, the amputation rate was 48% before 1992 and only 18% after that (p=0.02). Usage of more intensive multi-agent chemotherapy after 1992 could play the most important role in the advancement. |
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