Long-Term Results of Limb Salvage and Amputation in Extremity Osteosarcoma

Between July 1976 and December 1981, 46 patients seen at the Dana Farber Cancer Institute and the Children’s Hospital (DFCI/TCH) who met the criteria of being less than 30 years of age, without evidence of metastatic disease by plain chest radiograph, bone scan, and whole lung or computed tomography, were entered into this study. Detailed discussions relative to the merits and safety of limb salvage (LS) surgery were carried out in each case felt by the surgeon (HGW) to be a candidate for LS. Criteria for LS were: proximal humeral primaries if the brachial artery was univolved, midfemur lesions if the distal growth plate could be safely spared, distal femur or proximal fibular lesions if sufficient linear growth had been achieved, and lesions in an expendable bone (e.g., fibula). In all cases, a minimum of a wide margin was attempted. The chemotherapy regimen included vincristine (2 mg/m2), methotrexate (7.5 gm/m2) with leucovorin rescue, and doxorubicin (75 mg/m2) to a total of 450 mg/m2. All operative reports and staging studies were reviewed and the operative procedures classified as marginal, wide, or radical. Survival median curves were estimated by the method of Kaplan and Meier. Sixty-one patients who met the eligibility requirements for this study and were treated at the DFCI/TCH between 1948 and 1972 served as historical controls.