The success of limb-salvage surgery in the adolescent patient with osteogenic sarcoma.

Malignant bone tumors in the adolescent population are rare but serious problems that are both life- and limb-threatening. Most of these tumors originate in the extremities, hip girdle, or pelvic girdle and require complete surgical resection for adequate therapy. The greatest majority of these tumors are diagnosed as osteogenic sarcomas. In the past, limb ablation was the only effective therapeutic option available to surgical oncologists in adolescent osteosarcoma patients. However, today, after two decades of advances in chemotherapy protocols and reconstructive surgical techniques, limb-salvage surgery has become an accepted treatment standard. Because skeletal immaturity and future bone growth is generally not a major reconstructive consideration in adolescents, 90% of the patients in this age group are today treated with limb-sparing surgery. The most significant question regarding the successful use of limb-salvage surgery is whether it adversely affects long-term outcome compared with standard amputations. The principal studies, both single- and multi-institutional, that compared the risk of local tumor recurrence and overall disease-free survival rate of the two types of procedures, demonstrated no significant difference in disease-free survival rates between the two groups. Similarly, multivariant analyses have shown no survival benefit for choice of surgical procedure in osteosarcoma patients. As a result, limb-sparing surgery for osteosarcoma patients has now been firmly established as a safe, effective, and successful oncology procedure compared with limb ablation.