Treatment Options for Local Recurrence

Treatment options for patients with osteosarcoma or UPS of bone that has recurred locally include the following:

The postrelapse outcome of patients who have a local recurrence is quite poor.[50-52] Survival of patients with local recurrences and either previous or concurrent systemic metastases is poor.[53]

Two retrospective, single-institution series reported a survival rate of 10% to 40% after local recurrence without associated systemic metastasis.[53-56]

A retrospective review from the Italian Sarcoma Group identified 62 patients (median age, 21 years) with local recurrences.[57] With a median follow-up of 43 months (range, 5–235 months), the 5-year post–local relapse survival rate was 37%, significantly better for patients with a longer local recurrence–free interval (≤24 months, 31% vs. >24 months, 61.5%; P = .03), absence of distant metastases (no distant metastases, 56% vs. distant metastases, 11.5%; P = .0001), and achievement of second complete remission (CR) by surgical resection (no second CR, 0% vs. second CR, 58.5%; P = .0001). No difference in post–local relapse survival was found according to age, and there was no benefit from chemotherapy administration.

The incidence of local relapse was higher in patients who had a poor pathological response to chemotherapy in the primary tumor and in patients with inadequate surgical margins.[50,55]