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KMID : 0613320060120010037
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Journal of the Korean Bone and Joint Tumor Soceity
2006 Volume.12 No. 1 p.37 ~ p.46
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Clinical Outcome of Treatment for Stage ⅡA, ⅡB and Ⅲ Osteosarcomas (Comparative Studies between Invasive Surgical Treatment and Non-invasive HIFU Technique)
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Wenzhi Chen
Wang Wei
Zhibiao Wang
Hui Zhu
Kequan Li
Hao Piao-Xiang
Haibing Su
Chengbing Jin
Feng Wu
Jin Bai
Rhee Seung-Koo
Kang Yong-Koo
Park Won-Jong
Chung Yang-Guk
Huh Sung-Woo
Lee Eun-Sang
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Abstract
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Purpose: To evaluate the end results between the surgical treatment with neo-adjuvant chemotherapy in Korea and non-invasive high intensity focused ultrasound (HIFU) technique in China for osteogenic sarcomas.
Materials and Methods: The surgical treatment with neoadjuvant chemotherapy for total 67 cases (4 ⅡA, 58 ⅡB, and 5 Ⅲ) in Korea since 1993 and the HIFU therapy for total 71 cases (57 Ⅱ and 14 Ⅲ) in China since 1997 was performed. In Korea, neo-adjuvant chemotherapy in 66 cases out of total 67 patients, but the adjuvant chemotherapy in only one case was done. On the contrary, in China, full chemotherapy for more than 9 times for 37 patients with stage Ⅱ out of total 71 cases, but for less than 8 times of partial chemotherapy for 23 patients (stage Ⅱ) and 14 patients (stage Ⅲ) was done. The surgical treatment in total 67 Korean patients was done with wide resection and reconstruction for 56 patients, but wide resection without reconstruction for 5 patients and amputation for 6 patients. In china, total 71 patients was treated with average 1.5 times (1~4 times) of HIFU, and if there are some evidences of residual tumor after HIFU with following MRI, the second HIFU therapy was given 2~4 weeks later. After then, the bony defect was in no touch, keep bracing for long time expecting regeneration. All of them were followed for average 46 Mo (12~150 Mo) in Korea, but followed for average 22 Mo (9 years~8 months) in China.
Results: The 5 year survival rate (stage II), was average 92.7% (IIA 100%, IIB 85.5%) in Korea series, and average 78.7% (full chemotherapy 91.8%, part chemotherapy 56.6%) in China series. The 3 year survival rate (stage III) was 20% in Korea and 7.1% in China. So, the final overall survival rate was 65.2% in Korea and 51.8% in China. The overall functional outcome score by ISOLS was 24.3 (81%) in Korea and 19.8 (73%) in China. There are 25.4% (17/67 cases) of complications in Korea and 31% (27 complications in 22 patients out of total 71 cases) in China after each treatment.
Conclusions: The end results of Korea series which was treated with neoadjuvant chemo- and surgical methods are better than that of non-invasive thermal ablation in china. But we also believe the HIFU, as one of , was also effective to decrease the local recurrence and symptomatic releaf for stage Ⅱ or even in Ⅲ of osteogenic sarcomas.
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KEYWORD
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Osteogenic sarcoma, HIFU, Invasive surgical treatment, Non-invasive treatment
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