Neoadjuvant Chemotherapy Combined With Limb Salvage Surgery For The Treatment Of Limb Osteosarcoma

Objective: To study the clinical effect of neoadjuvant chemotherapy combined with limb salvage surgery for osteosarcoma.Methods: A retrospective analysis of 56 patients with osteosarcoma admitted to our hospital was conducted.According to the differences in previous treatment methods,the patients were divided into the traditional limb salvage group(group A)and the modern limb salvage group(group B).56 cases were collected in the first year,two years and three years,28 cases in each group,and 0 cases were lost to follow-up.48 cases were collected in the fourth year,22 cases were in group A and 6 cases were lost to follow-up.26 cases were in group B and 2 cases were lost to follow-up.The cause of follow-up loss was death of the patient.In the 5th year,43 cases were collected,19 cases were in group A,and 9 cases were lost to follow-up.There were 24 cases in group B and 4 cases were lost to follow-up.The cause of follow-up loss was death of the patient.In group A,the traditional limb salvage regimen,namely limb salvage surgery + postoperative adjuvant chemotherapy,was adopted.Group B adopted modern limb salvage regimen,namely preoperative neoadjuvant chemotherapy + limb salvage surgery + postoperative adjuvant chemotherapy.Preoperative neoadjuvant chemotherapy was performed by MTX1+ MTX1+ADM+DDP.If TNR≥90%,preoperative chemotherapy was continued after surgery;If TNR<90%,IFO+MTX2+ADM+DDP should be adopted.The recurrence rate,metastasis rate and survival rate,postoperative limb function and clinical efficacy were compared between the two groups at 1,2,3,4 and 5 years after operation.Results: The recurrence rates of the two groups were compared: 21.43% in group A and 3.57% in group B in the first year(P =0.043).In the second year,group A and group B were 35.71% and 10.71% respectively(P =0.041).In the third year,group A was 46.43% and group B was 17.86%(P =0.022).In the fourth year,59.09% of group 2A and 26.92% of group B(P =0.024).At year 5,group A was 73.68% and group B was 29.17%(P =0.004).The transfer rates of the two groups were compared: 21.43% in group A and 3.57% in group B in the first year(P =0.043).In the second year,group A was 32.14% and group B was 10.71%(P =0.027).In the third year,group A and group B were 35.71% and 14.29% respectively(P =0.046).50% in group 2A and 15.38% in group B at year 4(P =0.010);At year 5,63.16% in group A and 25% in group B(P =0.012).The survival rates of the two groups were compared: 92.86% in group A and 96.43% in group B at the first year(P =0.553).In the second year,82.14% of group A and 89.29% of group B(P=0.445).In the third year,group A was 53.57% and group B was 78.57%(P =0.048).In the fourth year,group A was 45.45% and group B was 76.92%(P =0.025).In the 5th year,group A was 31.58% and group B was 70.83%(P =0.010).The excellent and good rates of the two groups were compared: excellent 35.71%,good 21.43%,fair 25%,poor 17.86%,excellent and good 57.14% in group A,excellent 46.43%,good 35.71%,fair 10.71%,poor 2.14%,excellent and good rate 82.14% in group B(P =0.043).The limb functions of the two groups were compared: CR 14.29%,PR 35.71%,SD 17.86%,PD 32.14% and effective rate 50% in group A,and CR 28.57%,PR 50%,SD 14.19%,PD 7.14% and effective rate 78.57% in group B(P =0.018).Conclusions: Neoadjuvant chemotherapy combined with limb salvage surgery can improve the clinical efficacy and 5-year survival rate of patients with osteosarcoma,improve limb function,and reduce the recurrence rate and metastasis rate.