Treatment Outcome of Pelvic Osteosarcoma a 20 Year Experience in a Single Institution

Jae Do Kim, Cheung Kue Kim, So Hak Chung

Department of Orthopaedic Surgery, Koisn University Gospel Hospital, Busan, Korea.

DOI: 10.4236/jct.2013.41037                

Abstract

Purpose: Osteosarcoma of limbs shows excellent therapeutic results due to development of diagnostic and treatment methods. However, osteosarcoma of pelvic bone is known to have lower incidence than those of limbs and poorer prognosis. This study is performed to research the diagnosis, treatment, treatment outcomes, and complications of osteosarcoma of pelvic bone and propose standards for adequate treatment. Objective and Method: 16 cases that were diagnosed as osteosarcoma of pelvic bone from January 1988 to October 2010 in Kosin University Gospel Hospital were analyzed. Follow-up periods were at least 2 months up to 60 months. There were 6 cases of male and 10 cases of female, and mean age was 44.3 (14 ~ 74) years old. 5 cases were accompanied by pulmonary metastasis at the time of the diagnosis. Surgical treatment including preoperative and postoperative chemotherapy was performed in 9 cases, and only chemotherapy and radiation were performed in 1 case. Among 9 cases having undergone surgical treatment, 3 cases were performed with biological reconstruction using autogenous bone graft and total hip replacement together, 1 case was performed with extracorporeal irradiated recycled autogenous bone graft, 1 case was performed with reconstruction using tumor prosthesis, and 4 cases were performed with wide excision. Retrospective review was done about diagnostic procedures, treatment methods and results, and complications. Results: Mean period from the onset of symptoms to the time of the diagnosis was 6.3 (3 ~ 12) months, and the symptoms were 7 cases of hip pain, each 3 cases of lumbar pain and radiating pain to lower limbs, pelvic mass, each 2 cases of inguinal pain, and each 1 case of thigh pain, Among the 9 cases performed with preoperative and postoperative chemotherapy and surgical treatment, there were 6 cases of T-10 protocol, 2 cases of T-20 protocol, and 1 case of IA (Intraarterial) Cis protocol. In the 1 case that haven’t undergone surgical treatment, T-10 protocol was performed. 13 of the 16 cases were expired, with the mean time of 15 (2 ~ 47 months) from the time of the diagnosis to death. Complications were 4 cases of surgical infection, and 1 case of peroneal nerve palsy. Conclusion: Osteosarcoma occurred in the pelvic bone may delay the start of the diagnosis and treatment, and prognosis is too bad. Early diagnosis is important, and this purpose, high-resolution and precise imaging tests performed with tumorrelated blood tests is necessary. In addition, preoperative systemic chemotherapy, rather than intra-aterial chemotherapy is recommended.

Keywords

Osteosarcoma; Pelvis; Limb Salvage

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	A. Kawai, A. G. Huvos, P. A. Meyers and J. H. Healey, “Osteosarcoma of the Pelvis: Oncologic Result of 40 Patients,” Clinical Orthopaedics, Vol. 348, 1998, pp. 196-207.
[2]	M. Fahey, S. S. Spnier and R. A. Vander Griend, “Osteosarcoma of the Pelvis. A Clinical and Histopathological Study of Twenty Five Patients,” The Journal of Bone & Joint Surgery, Vol. 74, No. 3, 1992, pp. 321-330.
[3]	W. F. Taylor, J. C. lvins, D. C. Dahlin, et al., “Trends and Variability in Survival from Osteosarcoma,” Mayo Clinic Proceedings, Vol. 53, No. 11, 1978, pp. 695-700.
[4]	S. S. Beilack, B. Kempf-Bielack, G. Delling, et al., “Prognostic Factors in High Grade Osteosarcoma of the Extremities or Trunk: An Anlaysis of 1,702 Patients Treated Onneoadjuvant Cooperative Osteosarcoma Study Group Protocols,” Journal of Clinical Oncology, Vol. 20, No. 3, 2002, pp. 776-790. doi:10.1200/JCO.20.3.776
[5]	L. D. Wurtz, T. D. Peabody and M. A. Simon, “Delay in the Diagnosis and Treatment of Primary Bone Sarcoma of the Pelvis,” The Journal of Bone & Joint Surgery, Vol. 81, No. 3, 1999, pp. 317-325.
[6]	R. J. Grimmer, S. R. Carter, R. M. Tillman, et al., “Osteosarcoma of the Pelvis,” The Journal of Bone & Joint Surgery, Vol. 81, 1999, pp. 796-802. doi:10.1302/0301-620X.81B5.9241
[7]	W. F. Enneking, W. Dunham, M. C. Gebhardt and M. Malawer, D. J. Pritchard, “A System for the Functional Evaluation of Recontructive Procedures after Surgical Treatment of Tumors of the Musculoskeletal System,” Clinical Orthopaedics and Related Research, Vol. 286, 1993, pp. 241-246.
[8]	W. F. Enneking, S. S. Spanier and M. A. Goodman, “A System for the Surgical Staging of Musculoskeletal Sarcoma,” Clinical Orthopaedics and Related Research, Vol. 153, 1980, pp. 106-120.
[9]	M. I. O’Connor and F. H. Sim, “Salvage of the Limb in the Treatment of Malignant Pelvic Tumors,” The Journal of Bone & Joint Surgery, Vol. 71, No. 4, 1989, pp. 481-494.
[10]	W. F. Enneking and W. K. Dunham, “Resection and Reconstruction for Primary Neoplasms Invovling the Innominate Bone,” The Journal of Bone & Joint Surgery, Vol. 60, No. 6, 1978, pp. 731-746.
[11]	J. P. Kouie, T. A. M’Bengue, J. Andoh, et al., “Pelvic Osteosarcoma: Problems in Management,” Medical and Pediatric Oncology, Vol. 22, No. 3, 1994, pp. 204-207. doi:10.1002/mpo.2950220310
[12]	P. Bieling, N. Rehan, P. Winkler, et al., “Tumor Size and Prognosis in Aggressively Treated Osteosarcoma,” Journal of Clinical Oncology, Vol. 14, No. 3, 1996, pp. 848-858.
[13]	L. D. Wurtz, T. D. Peabody and M. A. Simon, “Delay in the Diagnosis and Treatment of Primary Bone Sarcoma of the Pelvis,” The Journal of Bone & Joint Surgery, Vol. 81, No. 3, 1999, pp. 317-325.
[14]	B. H. Pollock, J. P. Krischer and T. J. Vietti, “Interval between Symptom Onset and Diagnosis of Pediatric Solid Tumor,” Journal of Pediatrics, Vol. 119, No. 5, 1991, pp. 725-732. doi:10.1016/S0022-3476(05)80287-2
[15]	A. J. Abuolafia, R. Buch, J. Mathews, W. Li, M. M. Malawer, “Reconstruction Using the Saddle Prosthesis Following Excision of Primary and Metastatic Periacetabular Tumors,” Clinical Orthopaedics and Related Research, Vol. 314, 1995, pp. 203-213.
[16]	R. S. Bell, A. M. Davis, J. S. Wunder, T. Buconjic, McGoveran and A. E. Gross, “Allograft Recontruction of the Acetabulum after Resection of Stage-IIB Sarcoma, Intermediate-Term Results,” The Journal of Bone & Joint Surgery, Vol. 79, No. 11, 1997, pp. 1663-1674.
[17]	A. Abudu, R. J. Grimmer, S. R. Cannon, S. R. Carter and R. S. Sneath, “Reconstruction of the Hemipelvis after the Excision of Malignant Tumors. Complications and Fuctional Outcome of Prostheses,” The Journal of Bone & Joint Surgery. American Volume, Vol. 79, No. 11, 1997, pp. 773-779. doi:10.1302/0301-620X.79B5.6749
[18]	R. Capanna, J. R. Van Horn and N. Guernelli, “Complications of Pelvic Resections,” Archives of Orthopaedic and Trauma Surgery, Vol. 106, No. 2, 1987, pp. 71-77. doi:10.1007/BF00435417
[19]	R. B. Stephenson, H. Kaufer and F. M. Hankin, “Partail Pelvic Resection as an Alternative to Hindquarter Amputation for Skeletal Neoplasms,” Clinical Orthopaedics and Related Research, Vol. 242, 1989, pp. 201-211.
[20]	M. Campanacci and R. Capanna “Pelvic Rescetions: The Rizzoli Institute Experience,” Orthopedic Clinics of North America, Vol. 22, No. 1, 1991, pp. 65-86.
[21]	B. G. I. Spiegelberg, K. Gokaraju, M. T. Parratt, A. M. Flanagan, S. R. Cannon and T. W. R. Griggs, “Late Recurrence of Pelvic Osteosarcoma: A Case Report and Review of the Literature,” Grand Rounds, Vol. 10, 2010, pp. 8-12.
[22]	K. D. Harrington, “The Use of Hemipelvic Allografts for Reconstruction after Wide Resections of Malignent Tumors of the Pelvis,” The Journal of Bone & Joint Surgery. American Volume, Vol. 74, No. 3, 1992, pp. 331-341.
[23]	C. F. Lord, M. C. Gebhart, W. W. Tomford and H. J. Mankin, “Infection in Bone Allografts. Incidence, Nature and Treatment,” The Journal of Bone & Joint Surgery Infection in Bone Allografts. Incidence, Nature and Treatment, Vol. 70, No. 3, 1998, pp. 369-376.
[24]	A. Uchida, A. Myoul, N. Araki, H. Yoshikawa, T. Ueda and Y. Aoki, “Prosthetic Reconstruction for Periacetabular Malignant Tumors,” Clinical Orthopaedics and Related Research, Vol. 326, 1996, pp. 238-245. doi:10.1097/00003086-199605000-00029
[25]	R. Windhager, J. Karner, H. P. Kutschera, P. Polterauer, M. Salzer-Kuntschik and R. Kotz, “Limb Salvage in Periacetabular Sarcoma: Review of 21 Consecutive Cases,” Clinical Orthopaedics and Related Research, Vol. 331, 1996, pp. 265-276. doi:10.1097/00003086-199610000-00038
[26]	P. K. Jaiswal, W. J. S. Aston and R. J. Grimer, “Peri-Acetabular Resection and Endoprosthetic Reconstruction for Tumorurs of Acetabulum,” The Journal of Bone & Joint Surgery, Vol. 90, No. 9, 2008, pp. 1222-1227. doi:10.1302/0301-620X.90B9.20758
[27]	G. Bacci, S. Ferrari, A. Longhi, D. Mellano, S. Giacomini and C. Forni, “Delay in Diagnosis of High-Grade Osteosarcoma of the Extermity. Has It Any Effect on the Stage of Disease?” Tumor, Vol. 86, No. 3, 2000, pp. 235-237.
[28]	A. J. Abouolafia and M. M. Malawer, “Surgical Management of Pelvic and Extremity of Osteosarcoma,” Cancer, Vol. 71, Suppl. 10, 1993, pp. 3358-3366. doi:10.1002/1097-0142(19930515)71:10+<3358::AID-CNCR2820711738>3.0.CO;2-O
[29]	T. Ozaki, S. Flege and M. Kevric, “Osteosarcoma of the Pelvis: Experience of the Cooperative Osteosarcoma Study Group,” Journal of Clinical Oncology, Vol. 21, No. 2, 2003, pp. 334-41. doi:10.1200/JCO.2003.01.142