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Table of Contents
Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 122-123

Limb salvage surgery in osteosarcoma: Comment on Indian perspective

Department of Surgical Oncology, Tata Memorial Hospital, Parel; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India

Date of Submission13-Jan-2020
Date of Acceptance13-Jan-2020
Date of Web Publication24-Feb-2020

Correspondence Address:
Suresh Muthusamy
Department of Surgical Oncology, Tata Memorial Hospital, Dr. E Borges Road, Parel, Mumbai - 400 012, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CRST.CRST_21_20

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How to cite this article:
Muthusamy S. Limb salvage surgery in osteosarcoma: Comment on Indian perspective. Cancer Res Stat Treat 2020;3:122-3

How to cite this URL:
Muthusamy S. Limb salvage surgery in osteosarcoma: Comment on Indian perspective. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Apr 10];3:122-3. Available from: http://www.crstonline.com/text.asp?2020/3/1/122/279099

I have read the original article entitled, 'Life and limb after limb salvage surgery for osteosarcoma in an Indian Tertiary Cancer Center' along with the accompanying editorial, published in the current issue of the journal.[1],[2] I want to congratulate the authors for this article and make some contributions.

The positive thing worth mentioning about this article is that it is a single-institutional study, thereby eliminating the biases due to different surgical techniques and treatment protocols which are inherent to multi-institutional studies and this study has a longer period of median follow-up compared to other studies done in the Indian setting.[3],[4],[5]

Apart from reiterating the fact that chemotherapy-induced tumor necrosis is a favorable prognostic factor, the authors have concluded that the oncological outcomes are comparable to other studies from the world literature. I feel that only one of the quoted studies, i.e., by Puri et al.,[3] is comparable with the present study, the reason being that three of the studies have smaller sample sizes and shorter period of median follow-up.[4],[5],[6] The other two studies by Bielack et al.[7] and Bacci et al.[8] have large sample sizes and long follow-up, but they were done in patients before 1998 and 1989 respectively, and there have been tremendous improvements in surgical techniques, prosthesis, and chemotherapy regimens since then.[9]

The study by Puri et al., is comparable, as it is done in the Indian population around the same time period as the present study, but it has a larger sample size of 853 as compared to 41 in the present study.[3] However, the reported overall survival and event-free survivals were poorer as compared to the Western data and the authors claimed that it was due to delay in referral and large primary tumors in the Indian setting. We would like Dr. Ankalkoti et al. to discuss this furthur.

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  References Top

Ankalkoti B, Pareekutty NM, Kattepur AK, Kumbakara R, Vazhayil R, Balasubramanian S. Life and limb after limb salvage surgery for osteosarcoma in an Indian tertiary cancer center. Cancer Res Stat Treat 2019;2:145-51.  Back to cited text no. 1
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Tiwari A. Management of bone and soft-tissue sarcomas: From state of practice to state of art. Cancer Res Stat Treat 2019;2:215-6.  Back to cited text no. 2
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Puri A, Byregowda S, Gulia A, Crasto S, Chinaswamy G. A study of 853 high grade osteosarcomas from a single institution-Are outcomes in Indian patients different? J Surg Oncol 2018;117:299-306.  Back to cited text no. 3
Tiwari A, Jain S, Mehta S, Kumar R, Kapoor G, Kumar K. Limb salvage surgery for osteosarcoma: Early results in Indian patients. Indian J Orthop 2014;48:266-72.  Back to cited text no. 4
[PUBMED]  [Full text]  
Sukumaran RK, Rajeshwari B, Sugath S, Chellappan SG, Thankamony P, Parukuttyamma K. Methotrexate Free Chemotherapy and Limb Salvage Surgery for Paediatric Osteosarcoma in India. Indian J Orthop 2018;52:58-64.  Back to cited text no. 5
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Vasquez L, Tarrillo F, Oscanoa M, Maza I, Geronimo J, Paredes G, et al. Analysis of prognostic factors in high-grade osteosarcoma of the extremities in children: A 15-year single-institution experience. Front Oncol 2016;6:22.  Back to cited text no. 6
Bielack SS, Kempf-Bielack B, Delling G, Exner GU, Flege S, Helmke K, et al. Prognostic factors in high-grade osteosarcoma of the extremities or trunk: An analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol 2002;20:776-90.  Back to cited text no. 7
Bacci G, Ferrari S, Bertoni F, Ruggieri P, Picci P, Longhi A, et al. Long-term outcome for patients with nonmetastatic osteosarcoma of the extremity treated at the istituto ortopedico rizzoli according to the istituto ortopedico rizzoli/osteosarcoma-2 protocol: An updated report. J Clin Oncol 2000;18:4016-27.  Back to cited text no. 8
Turkar S. Current treatment landscape and emerging management options for extremity sarcoma. Cancer Res Stat Treat 2018;1:121-38.  Back to cited text no. 9
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