Résumé
BACKGROUND: The purpose of this study is to evaluate the disease-free survival (DFS) and overall survival (OS) of patients with stage IIB osteosarcoma at a single institution for 20 years and to compare the results according to the chemotherapy protocols. METHODS: From Jan 1988 to Nov 2008, 167 patients with osteosarcoma were treated at our hospital and among them, 117 patients (67 males and 50 females) with stage IIB osteosarcoma were evaluable. Their mean age was 22.6 years (range, 8 months to 71 years). Seventy-eight cases underwent the modified T10 (M-T10) protocol (group 1), 23 cases underwent the T20 protocol (group 2) and 16 cases underwent the T12 protocol (group 3). The DFS and OS were calculated and compared according to the chemotherapy protocols. RESULTS: At a mean follow-up of 78.9 months, 63 patients were continuously disease-free (63/117), 6 patients were alive after having metastatic lesions, 7 patients died of other cause and 41 patients died of their disease. The 5- and 10-year OS rates were 60.2% and 44.8%, respectively and the 5- and 10-year DFS rates were 53.5% and 41.4%, respectively. There was no significant difference of the OS and DFS between the chemotherapy protocols (p = 0.692, p = 0.113). CONCLUSIONS: At present, we achieved success rates close to the internationally accepted DFS and OS. We were able to achieve the higher survival rates using the M-T10 protocol over the 20 years. However, there was no significant difference of results between the chemotherapy protocols. We think the M-T10 protocol will achieve more favorable results in the near future.
Sujets)
Adolescent , Adulte , Sujet âgé , Enfant , Enfant d'âge préscolaire , Femelle , Humains , Nourrisson , Mâle , Adulte d'âge moyen , Jeune adulte , Protocoles de polychimiothérapie antinéoplasique/administration et posologie , Bléomycine/administration et posologie , Tumeurs osseuses/traitement médicamenteux , Traitement médicamenteux adjuvant , Cyclophosphamide/administration et posologie , Dactinomycine/administration et posologie , Survie sans rechute , Doxorubicine/administration et posologie , Études de suivi , Estimation de Kaplan-Meier , Leucovorine/administration et posologie , Méthotrexate/administration et posologie , Traitement néoadjuvant , Ostéosarcome/traitement médicamenteux , Taux de survie , Vincristine/administration et posologieRésumé
PURPOSE: We evaluated the complications of allograft reconstruction after a bone tumor resection, and reviewed literatures to overcome such complications. MATERIALS AND METHODS: We retrospectively reviewed clinical records and radiographs of fifteen patients in whom reconstruction with allograft after bone tumor resection. RESULTS: Eight patients were men and seven were women with a mean age of 27.1 years (1-56 years) and a mean follow-up period of 89.5 months (33-165 months). All postoperative complications related to the allograft were recorded. Twenty patients (80.0%) obtained a radiologic bony union at a mean of 8.35 months (4-12 months). The mean Musculoskeletal Tumor Society score was 73.5% (46.6-93.0%). Nine patients (60.0%) experienced one event and 3 (20.0%) patients experienced multiple events during the follow-up period. Recorded events were infection (3), fracture (2), nonunion (2), limb length discrepancy (2) and varus deformity (2). The mean event free survival period was 60.8 months (6-144 months). The mean allograft survival period was 80.2 months and the 5 year survival rate of the allografts was 83.0%. CONCLUSION: In order to overcome complications, the combination of an allograft and vascularized fibular graft is highly recommended. In the near future, the tissue engineering technique, the application of the stem cell and PRP, could reduce the complication of allograft such as resorption and nonunion.