Distal Radius Osteosarcoma

Won Seok Song; Ho-Hyun Won; Jeong-Dong Lee; Dae-Geun Jeon

doi:10.5292/jkbjts.2010.16.2.55

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Song, Won, Lee, and Jeon: Distal Radius Osteosarcoma

Original Article

J Korean Bone Joint Tumor Soc 2010;16(2):55-61.

Published online: 17 December 2010

DOI: https://doi.org/10.5292/jkbjts.2010.16.2.55

Distal Radius Osteosarcoma

Won Seok Song, M.D., Ho-Hyun Won, M.D., Jeong-Dong Lee, M.D., Dae-Geun Jeon, M.D.

Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea

Correspondence to: Dae-Geun Jeon, M.D. Department of Orthopaedic Surgery, Korea Cancer Center Hospital, 215-4, Gongneung-dong, Nowon-gu, Seoul 139-706, Korea TEL: +82-2-970-1242 FAX: +82-2-970-2403 E-mail: dgjeon@kcch.re.kr

Received 10 August 201030 September 2010 Accepted 20 October 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We analyzed the clinical outcome of osteosarcoma developed in distal radius and the effect of delayed treatment on prognosis.

Materials and Methods

Twelve patients with distal radius osteosarcoma were analysed. We categorized patients into two groups of standard treatment or non-standard treatment. The patients of standard treatment group are all stage IIB and non-standard treatment group includes five stage IIB and one stage III.

Results

Five-year overall survival and disease-free survival rates of standard treatment group were 100% and 83%. Five-year overall survival rate of non-standard treatment group was 44%. Between two group, there are differences in age, tumor size, surgery type, symptom duration.

Conclusion

Distal radius osteosarcoma have good prognosis than other extremity osteosarcoma. Survival rate of non-standard treatment group were lower than standard treatment group. Although the prognosis of non standard treatment group is poorer, the duration till death was longer than that of other sites with similar condition. Further multi-institutional study should be needed.

Keywords: osteosarcoma, distal radius, outcome

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Figure 1.

(A) Initial plain radiograph of 6-year-old patient (Case 1) shows osteoblastic lesion with periosteal reaction on distal radius. (B) Wide excision and wrist arthrodesis was done with pasteurized bone and Ender nail.

Figure 2.

Radiograph of 53-year-old female taken 15 months after curettage at other hospital shows huge bulging mass with bone destruction. She was treated with amputation and adjuvant chemotherapy, but died with metastasis 4 months after operation.

Table 1.

Summary of Patients

	Age	Sex	Size (ml)	Enneking stage	Tx delay	Duration of Tx delay	X-ray	Subtype	Op	Reconstruction	Tx
1	6	F	26.2	IIB	N	N	Blastic	OB	LS	Pasteurizaton	Op, Ch
2	10	F	11.5	IIB	N	N	Blastic	OB	LS	Cement filling	Op, Ch
3	12	F	9.0	IIB	N	N	Lytic	GCT	LS	Cement filling	Op, Ch
4	14	M	41.9	IIB	N	N	Mixed	OB	LS	Fibular graft	Op, Ch
5	14	F	10.4	IIB	N	N	Blastic	OB	LS	Cement filling	Op, Ch
6	16	F	42.0	IIB	N	N	Blastic	OB	LS	Fibular graft	Op, Ch
7	10	F	83.0	IIB	Y	47	Mixed	T	AP	None	Op, Ch, RT
8	20	M	139.7	IIB	Y	3	Mixed	OB	LS	Cement filling	Op, Ch
9	40	F	146	IIB	Y	24	Blastic	OB	AP	None	Op
10	44	M	450	IIB	Y	32	Mixed	OB	AP	None	Op, Ch
11	53	F	339	IIB	Y	15	Lytic	FB	AP	None	Op, Ch
12	61	M	1,524.7	III	N	120	Blastic	OB	AP	None	Op

Tx, treatment; X-ray, pattern on plain radiograph; Subtype, pathologoc subtype; OB, osteoblastic; FB, fibroblastic; GCT, giant cell type; T, telangiectatic; LS, limb sparing operation; AP, amputation; Op, operation; Ch, chemotherapy; RT, radiotherapy.

Table 2.

Clinical Outcomes

	Age	Tx	Rec	Rec time	Meta	Meta location	Meta time	F/S	F/U time	MSTS	Chemo response
1	6	Op, Ch	F	None	F	F	None	NED	52	25	50
2	10	Op, Ch	F	None	F	F	F	NED	75	24	100
3	12	Op, Ch	T	18	T	Lung	7	AWD	32	26	60
4	14	Op, Ch	F	None	F	F	F	NED	188	22	94
5	14	Op, Ch	F	None	F	F	F	NED	90	23	100
6	16	Op, Ch	F	None	F	F	F	NED	102	21	90
7	10	Op, Ch, RT	F	None	F	F	F	NED	113	NA	NA
8	20	Op, Ch	F	None	F	F	F	NED	19	26	80
9	40	Op	F	None	T	Lung	21.5	DOD	28.2	NA	NA
10	44	Op, Ch	F	None	T	Lung	9	AWD	37	NA	70
11	53	Op, Ch	F	None	T	Lung	2	DOD	4	NA	NA
12	61	Op	F	None	T	Lung	0	DOD	2	NA	NA

F, negative; T, positive; Rec, recurrence; Meta, metastasis; Op, operation; Ch, chemotherapy; RT, radiotherapy; F/S, final status; F/U, followup; NED, no evidence of disease; AWD, alive with disease; DOD, dead of disease; MSTS, Musculoskeletal Tumor Society functional score; NA, not assessed.

Table 3.

Comparison of Standard Treatment Group with Non-standard Treatment Group

	Standard	Non standard
Number	6	6
Age (years)
Median	13	42
Range	6-16	10-61
Gender
Male (%)	1 (16.7)	3 (50)
Female (%)	5 (83.3)	3 (50)
Tumor volume
Mean (range)	23.5 ml (9-42)	447.1 ml (83-1,524)^∗
Pattern on plain radiograph
Osteoblastic (%)	4 (66.7)	2 (33.3)
Osteolytic (%)	1 (16.7)	1 (16.7)
Myxed (%)	1 (16.7)	3 (50)
Pathologic subtype
Osteoblastic (%)	5 (83.3)	4 (66.7)
Fibroblastic (%)	0	1 (16.7)
Giant cell (%)	1 (16.7)	0
Telangiectatic (%)	0	1 (16.7)
Surgery
Limb-sparing (%)	6 (100)	1 (16.7)
Amputation (%)	0 (0)	5 (83.3)
Therapy
Operation only (%)	0	2 (33.3)
Operation+Chemotherapy (%)	6 (100)	3 (50)
Operation+Chemotherapy +Radiation (%)	0	1 (16.7)
Local recurrence (%)	1 (16.7)	0
Distant metastasis (%)	1 (16.7)	4 (66.7)
Status
Died of disease (%)	0	3 (50)
Alive with disease (%)	1 (16.7)	1 (16.7)
No evidence of disease (%)	5 (83.3)	2 (33.3)
Follow-up time (months)
Mean (range)	79.4 (32-188)	32.5 (2.3-112)

^∗ Tumor volume at referral.

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