Bone Radiation-Induced Sarcomas: Outcomes Based on Histology and Surgical Treatment: A Systematic Review of the Literature.

IF 1.7 Q2 SURGERY

JBJS Reviews Pub Date : 2024-08-05 eCollection Date: 2024-08-01 DOI:10.2106/JBJS.RVW.24.00066

Maria L Inchaustegui, Felipe Larios, Jean-Patrick Buteau, Marcos R Gonzalez, Juan Pretell-Mazzini

{"title":"Bone Radiation-Induced Sarcomas: Outcomes Based on Histology and Surgical Treatment: A Systematic Review of the Literature.","authors":"Maria L Inchaustegui, Felipe Larios, Jean-Patrick Buteau, Marcos R Gonzalez, Juan Pretell-Mazzini","doi":"10.2106/JBJS.RVW.24.00066","DOIUrl":null,"url":null,"abstract":"Background: Bone radiation-induced sarcomas (B-RIS) are secondary neoplasms with reportedly worse overall survival than de novo bone sarcoma. Treatment strategy for these neoplasms remains uncertain. Our systematic review sought to assess overall survival based on histology and surgical intervention.Methods: A systemic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered in PROSPERO (438415). Studies describing oncologic outcomes of patients with B-RIS in the appendicular and axial skeleton were included. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for quality assessment. Survival analysis by histologic subtype and surgery type was performed in a subset of 234 patients from 11 articles with individualized data. A total of 20 articles with a total of 566 patients were included. The most frequent location was the pelvis (27.7%), and the main histological types were osteosarcoma (69.4%), undifferentiated pleomorphic sarcoma (14.1%), and fibrosarcoma (9.2%). Limb-salvage and amputation were performed in 68.5% and 31.5% of cases, respectively.Results: Local recurrence was 13%, without difference between limb-salvage surgery and amputation (p = 0.51). The metastasis rate was 42.3%. Five-year OS was 43.7% (95% confidence interval [CI], 33.3%-53.5%) for osteosarcoma, 31.5% (95% CI, 11.3%-54.2%) for UPS, and 28.1% (95% CI, 10.6%-48.8%) for fibrosarcoma. Five-year OS was 49.2% (95% CI, 35.3%-61.6%) for limb-salvage and 46.9% (95% CI, 29.1%-62.9%) for amputation. There was no difference in 5-year OS between histologic subtypes (p = 0.18) or treatment type (p = 0.86).Conclusion: B-RIS demonstrated poor OS at 5 years after initial management regardless of histology. Limb-salvage surgery was not associated with lower 5-year OS compared with amputation. Future studies should compare both groups while controlling for confounders.Level of evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 8","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JBJS Reviews","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2106/JBJS.RVW.24.00066","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Bone radiation-induced sarcomas (B-RIS) are secondary neoplasms with reportedly worse overall survival than de novo bone sarcoma. Treatment strategy for these neoplasms remains uncertain. Our systematic review sought to assess overall survival based on histology and surgical intervention.

Methods: A systemic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered in PROSPERO (438415). Studies describing oncologic outcomes of patients with B-RIS in the appendicular and axial skeleton were included. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for quality assessment. Survival analysis by histologic subtype and surgery type was performed in a subset of 234 patients from 11 articles with individualized data. A total of 20 articles with a total of 566 patients were included. The most frequent location was the pelvis (27.7%), and the main histological types were osteosarcoma (69.4%), undifferentiated pleomorphic sarcoma (14.1%), and fibrosarcoma (9.2%). Limb-salvage and amputation were performed in 68.5% and 31.5% of cases, respectively.

Results: Local recurrence was 13%, without difference between limb-salvage surgery and amputation (p = 0.51). The metastasis rate was 42.3%. Five-year OS was 43.7% (95% confidence interval [CI], 33.3%-53.5%) for osteosarcoma, 31.5% (95% CI, 11.3%-54.2%) for UPS, and 28.1% (95% CI, 10.6%-48.8%) for fibrosarcoma. Five-year OS was 49.2% (95% CI, 35.3%-61.6%) for limb-salvage and 46.9% (95% CI, 29.1%-62.9%) for amputation. There was no difference in 5-year OS between histologic subtypes (p = 0.18) or treatment type (p = 0.86).

Conclusion: B-RIS demonstrated poor OS at 5 years after initial management regardless of histology. Limb-salvage surgery was not associated with lower 5-year OS compared with amputation. Future studies should compare both groups while controlling for confounders.

Level of evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.

查看原文本刊更多论文

骨放射诱发肉瘤：基于组织学和手术治疗的结果：文献的系统回顾。

背景：骨放射诱导肉瘤（B-RIS）是一种继发性肿瘤，据报道其总体生存率低于新生骨肉瘤。这些肿瘤的治疗策略仍不确定。我们的系统综述旨在根据组织学和手术干预评估总生存率：我们按照《系统综述和荟萃分析首选报告项目》指南进行了系统综述，并在 PROSPERO（438415）上进行了注册。纳入的研究描述了阑尾和轴突骨骼B-RIS患者的肿瘤治疗效果。采用流行病学观察性研究强化报告清单进行质量评估。根据组织学亚型和手术类型对11篇文章中234名患者的个体化数据进行了生存分析。共纳入了20篇文章，共计566名患者。最常见的部位是骨盆（27.7%），主要组织学类型为骨肉瘤（69.4%）、未分化多形性肉瘤（14.1%）和纤维肉瘤（9.2%）。分别有68.5%和31.5%的病例进行了肢体清创和截肢手术：结果：局部复发率为13%，截肢手术和保肢手术之间无差异（P = 0.51）。转移率为42.3%。骨肉瘤的五年生存率为43.7%（95%置信区间[CI]，33.3%-53.5%），UPS为31.5%（95%置信区间，11.3%-54.2%），纤维肉瘤为28.1%（95%置信区间，10.6%-48.8%）。截肢患者的五年生存率为49.2%（95% CI，35.3%-61.6%），截肢患者的五年生存率为46.9%（95% CI，29.1%-62.9%）。组织学亚型（P = 0.18）或治疗类型（P = 0.86）之间的5年OS无差异：结论：无论组织学如何，B-RIS在初始治疗后5年的OS较差。与截肢相比，肢体修复手术与较低的5年生存率无关。未来的研究应在控制混杂因素的同时对两组患者进行比较：证据等级：III级。有关证据级别的完整描述，请参阅 "作者须知"。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

JBJS Reviews SURGERY-

CiteScore

4.40

自引率

4.30%

发文量

132

期刊介绍： JBJS Reviews is an innovative review journal from the publishers of The Journal of Bone & Joint Surgery. This continuously published online journal provides comprehensive, objective, and authoritative review articles written by recognized experts in the field. Edited by Thomas A. Einhorn, MD, and a distinguished Editorial Board, each issue of JBJS Reviews, updates the orthopaedic community on important topics in a concise, time-saving manner, providing expert insights into orthopaedic research and clinical experience. Comprehensive reviews, special features, and integrated CME provide orthopaedic surgeons with valuable perspectives on surgical practice and the latest advances in the field within twelve subspecialty areas: Basic Science, Education & Training, Elbow, Ethics, Foot & Ankle, Hand & Wrist, Hip, Infection, Knee, Oncology, Pediatrics, Pain Management, Rehabilitation, Shoulder, Spine, Sports Medicine, Trauma.