Risk of local recurrence after deltoid‐sparing resection for osteosarcoma of the proximal humerus

Risk of local recurrence after deltoid‐sparing resection for osteosarcoma of the proximal humerus

BACKGROUND: The anatomy of the shoulder poses special challenges with regard to limb‐sparing surgery. Resection of the deltoid muscle is considered by some surgeons to be necessary to achieve adequate margins for osteosarcoma of the proximal humerus. However, this can compromise the functional resul...

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Bibliographic Details
Published in:Cancer Vol. 115; no. 16; pp. 3767 - 3773
Main Authors: Gupta, Giri R., Yasko, Alan W., Lewis, Valerae O., Cannon, Christopher P., Raymond, A. Kevin, Patel, Shreyaskumar, Lin, Patrick P.
Format: Journal Article Conference Proceeding
Language:English
Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 15-08-2009
Wiley-Blackwell
Subjects:
Adolescent
Adult
Biological and medical sciences
Chemotherapy, Adjuvant
Child
cisplatin
Diseases of the osteoarticular system
Female
Humans
Humerus
Male
Medical sciences
Muscles - blood supply
Muscles - surgery
Neoplasm Recurrence, Local
Orthopedic Procedures - methods
osteosarcoma
Osteosarcoma - surgery
shoulder
Time Factors
Tumors
Tumors of striated muscle and skeleton
Antineoplastic agent
Proximal
Relapse
Sarcoma
Diseases of the osteoarticular system
Surgical resection
Malignant tumor
Cisplatin
Osteoarticular system
Alkylating agent
Cancerology
Treatment
Osteosarcoma
Surgery
Shoulder
Risk factor
Bone
Humerus
Cancer
Platinum II Complexes
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Summary:BACKGROUND: The anatomy of the shoulder poses special challenges with regard to limb‐sparing surgery. Resection of the deltoid muscle is considered by some surgeons to be necessary to achieve adequate margins for osteosarcoma of the proximal humerus. However, this can compromise the functional results after reconstruction of the shoulder. The goal of the current study was to determine whether deltoid‐sparing resection can be safely performed for osteosarcoma of the proximal humerus. METHODS: Between 1978 and 2005, 23 consecutive patients with high‐grade nonmetastatic osteosarcoma of the proximal humerus underwent limb‐sparing surgery with preservation of the deltoid muscle. All patients received neoadjuvant chemotherapy followed by surgery and postoperative chemotherapy. The mean follow‐up was 90 months (range, 7 months‐279 months). RESULTS: The overall survival at 5 years was 77%. At the time of last follow‐up, 14 (61%) of 23 of patients were alive without evidence of disease. Three (13%) patients developed local recurrence. Two of these patients had poor responses to chemotherapy, with tumor necrosis of 50% and 70%. The third patient had a pathologic fracture of the humerus. Positive surgical margins were associated with local recurrence, and 2 of 4 patients with a positive surgical margin developed local recurrence (P = .01). CONCLUSIONS: Preservation of the deltoid muscle can be performed for carefully selected patients with osteosarcoma of the proximal humerus. Routine use of the procedure is not justified, because it may be associated with an elevated risk of recurrence. The risk of local recurrence appears to be related to positive surgical margins and possibly the percentage of tumor necrosis. Cancer 2009. © 2009 American Cancer Society. Preservation of the deltoid muscle after resection of the proximal humerus is important to reconstructive surgery for the shoulder. Careful selection of patients for deltoid‐preserving resection may be critical, because the risk of recurrence may be elevated with routine use of the procedure.
Bibliography:Presented at the 12th Annual Meeting of the Connective Tissue Oncology Society, Venice, Italy, November 2‐4, 2006.
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ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:0008-543X
1097-0142
DOI:10.1002/cncr.24443