|E-JCRT LETTERS TO THE EDITOR
|Year : 2015 | Volume
| Issue : 4 | Page : 1043
Does a pathological fracture affect the prognosis in patients with osteosarcoma of the extremities?
Abhijeet Ashok Salunke1, Yongsheng Chen2, Chen Xi3, Mark Puhaindran4
1 M. S. Patel Cancer Centre, Sri Krishna Hospital, Pramukswami Medical College, Karamsad, Anand, Gujarat, India
2 Department of Orthopedics, National University Hospital, Singapore
3 Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
4 Division of Musculoskeletal Oncology, National University Hospital, Singapore
|Date of Web Publication||15-Feb-2016|
Abhijeet Ashok Salunke
M. S. Patel Cancer Centre, Sri Krishna Hospital, Pramukswami Medical College, Karamsad, Anand, Gujarat
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Salunke AA, Chen Y, Xi C, Puhaindran M. Does a pathological fracture affect the prognosis in patients with osteosarcoma of the extremities?. J Can Res Ther 2015;11:1043
|How to cite this URL:|
Salunke AA, Chen Y, Xi C, Puhaindran M. Does a pathological fracture affect the prognosis in patients with osteosarcoma of the extremities?. J Can Res Ther [serial online] 2015 [cited 2020 Jul 3];11:1043. Available from: http://www.cancerjournal.net/text.asp?2015/11/4/1043/163790
We read with interest the article by Yang, who have demonstrated that presentation with a pathologic fracture in osteosarcoma was correlated with a poor prognosis. Moreover, pathologic fracture might be a poor predictor of survival in osteosarcoma.  The author has stated that previous works done with presentation with a pathologic fracture in osteosarcoma didn't have conclusive results.
It is unclear, however, as to how the pathological fracture affects local recurrence rate and type of surgery that is, limb salvage versus amputation. Surely the authors would acknowledge that the results available in the literature suggest that patients with pathological fracture who have been carefully selected to undergo limb salvage surgery may have similar outcomes in terms of local recurrence and survival to those who undergo amputation. Therefore, the pathological fracture is unlikely to be an absolute indication for amputation in patients with osteosarcoma. ,
In terms of the location of the tumor, there appears to be some suggestion that proximally located tumors are associated with a poorer outcome.  The literature suggests that in the presence of a pathological fracture, tumor location appears to be a less important predictor of outcome in patients with osteosarcoma. , The influence of margins as a prognostic factor is more relevant to the development of local recurrence and secondarily to the overall survival.  The objective is always to obtain the best possible margin, with current chemotherapy protocols effective limb salvage is possible, albeit with closer margins and pathological fracture. ,,,
The timing of the development of fracture and fracture displacement may theoretically be important prognostic predictors in patients with pathological fracture. Salunke et al., showed that 43.5% of patients had a pathological fracture at presentation, while 56.5% of patients developed a pathological fracture during treatment.  Additionally, 34.6% of the fractures were displaced whereas 65.4% were undisplaced.  Scully et al., reported no statistical correlation on either timing of fracture development or fracture displacement on outcome measures like a local recurrence and mortality rates.  Additionally, there are no studies in the literature which have looked at the effect of tumor size and hematoma size on clinical outcomes such as local and distant recurrence rates. The timing of fracture and other relevant fracture characteristics are may be the subject of evaluation in further trials.
In conclusion, the review of the literature suggest that pathological fracture is no absolute indication for amputation, as similar rates of local recurrence can be achieved in patients who are carefully selected for limb salvage.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| > References|| |
Yang M. Prognostic role of pathologic fracture in osteosarcoma: Evidence based on 1,677 subjects. J Cancer Res Ther 2015;11:264-7.
Salunke AA, Chen Y, Tan JH, Chen X, Khin LW, Puhaindran ME. Does a pathological fracture affect the prognosis in patients with osteosarcoma of the extremities? A systematic review and meta-analysis. Bone Joint J 2014;96-B: 1396-403.
Yin K, Liao Q, Zhong D, Ding J, Niu B, Long Q, et al.
Meta-analysis of limb salvage versus amputation for treating high-grade and localized osteosarcoma in patients with pathological fracture. Exp Ther Med 2012;4:889-894.
Bramer JA, Abudu AA, Grimer RJ, Carter SR, Tillman RM. Do pathological fractures influence survival and local recurrence rate in bony sarcomas? Eur J Cancer 2007;43:1944-51.
Reddy KI, Wafa H, Gaston CL, Grimer RJ, Abudu AT, Jeys LM, et al.
Does amputation offer any survival benefit over limb salvage in osteosarcoma patients with poor chemonecrosis and close margins? Bone Joint J 2015;97-B: 115-20.
Scully SP, Ghert MA, Zurakowski D, Thompson RC, Gebhardt MC. Pathologic fracture in osteosarcoma: Prognostic importance and treatment implications. J Bone Joint Surg Am 2002;84-A: 49-57.