Abstract
BACKGROUND:
The anatomy of the shoulder poses special challenges with regard to limbโsparing surgery. Resection of the deltoid muscle is considered by some surgeons to be necessary to achieve adequate margins for osteosarcoma of the proximal humerus. However, this can compromise the functional results after reconstruction of the shoulder. The goal of the current study was to determine whether deltoidโsparing resection can be safely performed for osteosarcoma of the proximal humerus.
METHODS:
Between 1978 and 2005, 23 consecutive patients with highโgrade nonmetastatic osteosarcoma of the proximal humerus underwent limbโsparing surgery with preservation of the deltoid muscle. All patients received neoadjuvant chemotherapy followed by surgery and postoperative chemotherapy. The mean followโup was 90 months (range, 7 monthsโ279 months).
RESULTS:
The overall survival at 5 years was 77%. At the time of last followโup, 14 (61%) of 23 of patients were alive without evidence of disease. Three (13%) patients developed local recurrence. Two of these patients had poor responses to chemotherapy, with tumor necrosis of 50% and 70%. The third patient had a pathologic fracture of the humerus. Positive surgical margins were associated with local recurrence, and 2 of 4 patients with a positive surgical margin developed local recurrence (P = .01).
CONCLUSIONS:
Preservation of the deltoid muscle can be performed for carefully selected patients with osteosarcoma of the proximal humerus. Routine use of the procedure is not justified, because it may be associated with an elevated risk of recurrence. The risk of local recurrence appears to be related to positive surgical margins and possibly the percentage of tumor necrosis. Cancer 2009. ยฉ 2009 American Cancer Society.