Figure 108-16. Plain radiograph of the femur showing a high-grade osteosarcoma. The tumor is an ill-defined destructive lesion

with an extensive soft tissue involvement. Codman triangles (arrows) indicate periosteal reaction, which are characteristic, but not

pathognomonic, of osteosarcoma.

Surgical resection is the definitive treatment for most chrondrosarcomas (Fig. 108-17).

Intracompartmental lesions can be considered for intralesional resection with wide margins. Radiation

can be considered as an adjuvant therapy, but chemotherapy is generally not very effective. If lesions

are unresectable, radiation may be considered as a possible definitive treatment modality.

Historically, patients with clinically localized osteosarcoma treated by surgery alone had a 5-year

survival rate of approximately 20%. Adjuvant systemic chemotherapy after surgery has greatly

improved that figure to 55% to 70% in most randomized trials.146,147 Several agents have shown to be

active and regimens have used differing combinations of those agents – doxorubicin, cisplatin,

ifosfamide, and high-dose methotrexate. Disease relapse should be treated with further chemotherapy

and repeat resection if possible. Progressive disease carries a poor prognosis.

Extremity osteosarcomas are ideally treated with limb-sparing approaches when possible to maximize

functional outcomes. Limb-sparing operations include complete removal of the affected bone and soft

tissues. A variety of reconstructive techniques are available after resection of an extremity

osteosarcoma. Autografts (such as vascularized or nonvascularized fibular grafts), cadaver allografts,

and sophisticated endoprostheses can be used. Because the osteosarcoma population includes many

children who continue to grow, modular prostheses that can periodically be expanded are increasingly

being used.

3200

Figure 108-17. Chondrosarcoma recurrence. A 60-year-old man had previously undergone resection of a low-grade

chondrosarcoma of the left pelvis, necessitating resection of the left iliac bone. After many local bony recurrences, he was found to

have an extraskeletal site of disease. On the CT scan, adjacent to the remaining bone, there is a 4.4- × 3.6-cm soft tissue mass

(arrow), which contains dystrophic calcifications. Recurrent disease was completely resected.

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