Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea.
J Surg Oncol. 2011 Mar 1;103(3):264-8. doi: 10.1002/jso.21822. Epub 2010 Dec 22.
The purpose of this study is to evaluate the risk of subsequent local recurrence (LR) and survival of parosteal osteosarcoma (POS) patients who underwent re-excision after intralesional excision.
We analyzed clinical outcomes of 11 POS patients referred after intralesional excision. Average follow-up was 86 months (range: 37-190 months). There were 9 Stage IB lesions and 2 Stage IIB lesions. Tumors were located in the femur (3) and in other locations (8). Seven patients showing recurrent tumor at referral received entire segmental excision while remaining four patients without LR underwent hemi-cortical excision.
The 5-year metastasis free survival rate of 11 patients was 81.8%. Patients without evident tumor mass did not show further recurrence after re-excision. However, 5 (71.4%) of the 7 patients with recurrent tumor relapsed despite segmental re-excision, and their median interval to subsequent LR was 18.8 months (range: 4-9 months). Two of five patients with re-recurrence developed metastases which were unresponsive to chemotherapy.
Following inadvertent intralesional procedure, re-excision should be liberally applied before there is an evidence of recurrence. In patients presenting with gross LR, amputation should not be spared unless wide surgical margin can be achieved.
本研究旨在评估行病灶内切除后再次行切除术的骨旁骨肉瘤（POS）患者的局部复发（LR）风险和生存情况。
我们分析了 11 例经病灶内切除后转诊的 POS 患者的临床结果。平均随访 86 个月（范围：37-190 个月）。9 例为 IB 期病变，2 例为 IIB 期病变。肿瘤位于股骨（3 例）和其他部位（8 例）。7 例有肿瘤复发的患者在转诊时接受了整块节段切除术，而其余 4 例无 LR 的患者接受了半皮质切除术。
11 例患者的 5 年无转移生存率为 81.8%。无明显肿瘤肿块的患者在再次切除后未出现进一步复发。然而，7 例有复发性肿瘤的患者中有 5 例（71.4%）尽管行节段性再次切除仍复发，其随后 LR 的中位间隔为 18.8 个月（范围：4-9 个月）。5 例再复发的患者中有 2 例发生了转移，对化疗无反应。
在有复发证据之前，应自由应用再次切除术来治疗不经意的病灶内手术。对于有明显 LR 的患者，除非可以达到广泛的手术切缘，否则不应避免截肢。
