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Prognostic Effect of Pathologic Fracture in Localized Osteosarcoma

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Author(s): Dae-Geun Jeon

Journal: The Asia-Pacific Journal of Oncology & Hematology
ISSN 1759-6637

Volume: 2;
Issue: 1;
Start page: 131;
Date: 2010;
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Keywords: pathologic fracture | osteosarcoma | prognosis | neoadjuvant chemotherapy | non-metastatic | extremity

ABSTRACT
Osteosarcoma is a rare disease, and osteosarcoma complicated by a pathologic fracture is even rarer, and thus, the prognostic effect of fracture in osteosarcoma on survival is not well understood. In the past, a pathologic fracture per se was considered as an absolute indication for amputation. However, after the introduction of neoadjuvant chemotherapy and limb salvage, the major issue is the possibility of limb salvage in this condition. Today, the concept that a pathologic fracture is not a contraindication to limb salvage is largely accepted. Nevertheless, it remains to be determined whether the presence of a fracture jeopardizes survival or whether it is merely a manifestation of an aggressive tumor biology. Clinicopathologic variables of major concern regarding the prognosis of pathological fractures caused by osteosarcoma are location, histologic subtype, tumor size, histologic response, and local recurrence. However, confounding correlations between variables overlaid with the heterogeneous effects of study design differences are likely to cause contradictory results. In this review article, the author discusses the prognostic effects of pathological fractures, especially in terms of relations with other clinicopathologic variables.
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