Surgical procedure and local recurrence in 223 patients treated 1982-1997 according to two osteosarcoma chemotherapy protocols. The Scandinavian Sarcoma Group experience.

In the present multicenter study from the Scandinavian Sarcoma Group, local recurrence was analyzed regarding a change in the chemotherapy protocol and an increasing number of limb-salvage procedures 1982-97. Surgery was performed at 13 hospitals in Scandinavia. We analyzed the data of 223 patients with non-metastatic, high-grade osteosarcoma of the extremities, treated according to the SSG II and VIII protocols. The rate of limb-salvage surgery was 0.3 in SSG II, as compared to 0.6 in SSG VIII. The local recurrence rates of the limb-salvage patients were 10% (SSG II) and 11% (SSG VIII), as compared to 4% and 2%, respectively, among the amputated patients. We found no significant difference in outcome i.e., in local recurrence and survival rate despite an increased rate of good responders in SSG VIII, as compared to SSG II. It may be shown that the continuously increasing use of limb-salvage surgery is associated with a higher rate of local recurrence than with ablative surgery, despite better chemotherapy.