The Inference Of Different Treatment Strategies And Chemotherapy On Clinical Efficacy Of Limb Osteosarcoma

ObjectiveTo investigate the clinical effect of standard treatment and different chemotherapy forpatients with osteosarcoma in extremity.MethodsClinical data of151patients with osteosarcoma in extremity have bean treatment fromJan1991to Dec2012in our cancer center.There were93males and58females,with themean age of19years(4-67years), the ratio of male to female reached1.60:1.The averagetreatment time was3.2months(5days to12months).The tumors located in the distal femurin68patients, proximal tibia in44,12cases of proximal fibula,11cases of proximalhumerus,8cases of proximal femur,four cases of distal tibial,shaft femur in3,and1case ofthe distal radius. Devitalization and replantation in55,artificial prosthetic operation in51,inactive bone replantation with preservation of the epiphysis in10,simple tumorresection in15cases,13cases of amputation, tumor resection autogenous bone graft in5cases, and2cases of tumor resection allogeneic bone grafting.With standard treatment in52,with no-standard treatment in83,with MMIA protocol in26,with DIA protocol in32.The differences of recurrence,pulmonary metastasis rate and survival rate,werecompared between the patients treated with different treatments.ResultsThe lost of follow-up in16(10.59%).Still survival patients in59had been followed upfor a median period of67months (13-252months),the remaining patients had beenfollowed up for a median period of21months (6-67months).There were138cases whounderwent limb surgery,the salvage rate was91.4%.1patient suffered side effects ofchemotherapy-induced thrombocytopenia, died of intracranial hemorrhage finally, eight patients underwent postoperative inactivated bone fractures, two cases occurred internalfixation material fracture,7patients infection of incision wound is not healing, four casesof postoperative prosthesis loosening, one case knee joint prosthesis flexion and extensionwas limited after operation.The recurrence in34,the recurrence rate was22.52%,12patients relapsed again so they had to underwent resection of localized tumors,11patientsrefused to continue treatment,3patients underwent radiotherapy on local recurrence orchemotherapy.Among the34relapsed patients,2have unknown outcome,29underwentlung metastases,4people survived with tumor, including one case of pulmonary metastasissurvives21years with tumor.There were8cases underwent amputation withrecurrence.There were5cases underwent amputation with complications.The successfulrate of limb-salvage operation was82.8%.Patients who were treated with standard methodshad a lower recurrence,pulmonary metastasis rate(13.5%,28.85%) and longer5-yeartumor-free survival rate and5-year overall survival rate(62.4%,65.7%)than that of thosewho treated with no-standard methods(28.9%,61.45%;18.5%,19.9%)(P<0.05).Patients whowere treated with DIA chemotherapy had a lower pulmonary metastasis rate(34.38%)andlonger5-year tumor-free survival rate(62.5%)and5-year overall survival rate (65.6%)thanthat of those who treated with MMIA chemotherapy(65.4%;34.6,34.6%)(P<0.05),but nosignificant difference between the two rates of recurrence (18.75%,26.9%).Conclusions1. standard treatment can reduce the recurrence, pulmonary metastasis rate of patientswith osteosarcoma,to improve the survival rate,and it is important to improve theprognosis of osteosarcoma.2. It is a safe and feasible chemotherapy with its efficacy of reliable,short cycle ofchemotherapy,good compliance and conducive to the implementation of standardtreatment.