Methods: Local recidivation (incidence, risk factors an prognosis) was analysed retrospectively in 765 patients with non-metastatic osteosarcoma of the extremities treated between 1972 and 1992 either with surgery alone (78 cases) or with surgery and associated adjuvant (258 cases) and neoadjuvant chemotherapy (429 cases).
Results: The local recurrence of the disease, which was documented in 26 patients (3.4%), was significantly related to the type of surgery performed (1.1% in 344 amputated patients vs 5.2% in 422 patients treated with resection; p < 0.003) and with surgical margins (0.6% in 700 radical or extensive operations vs 22.7% in 66 marginal or intralesional interventions; p = 0.0001). In patients treated with neoadjuvant chemotherapy, the incidence of local recidivation was also correlated with the type of histological response to chemotherapy (2.9% in 274 cases with a "good" response vs 8.4% in 154 cases with a "poor" response; p < 0.021). In all 26 patients local recidivation was associated with metastases occurring before (16 cases), after (3 cases) or in concomitance (7 cases) with the local recurrence of neoplasia. In spite of treatment performed at the start of recidivation, 25 patients (96.1%) died from the tumour whereas the mortality rate in those patients with metastases but no local recidivation was only 72.1% (261 out of 362 cases). This difference was also statistically significant (p < 0.01).
Conclusions: The results obtained appear to justify the current trend of minimising demolitive surgery in osteosarcoma of the extremities. Surgery should only be performed in these patients by centres able to make an adequate evaluation of surgical margins and the histological response to preoperative chemotherapy. In view of the fatal prognosis linked to recidivation and the high probability of its onset in cases with inadequate surgical margins and a poor response to chemotherapy, the authors propose that subsequent amputation should be performed immediately in those patients undergoing resection who present both these conditions.