الفهرس 
Title : Functional And Oncological Outcomes Of Patients With Proximal Humerus Osteosarcoma Treated By Limb Salvage And Chemotherapy
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Abstract
Our study was designed to assess the oncological outcome of proximal humerus and to see if it will be different from other locations, assess the functional outcome of different method of reconstruction and finally to see if there is any prognostic factors for both functional and oncological outcomes. The study is a retrospective cohort study assessing the overall outcome of 34 patients with proximal humerus osteosarcoma treated by limb sparing surgery and chemotherapy.
General information including demographics, reconstruction type and functional outcomes were reviewed. Local recurrence and distant metastasis were assessed clinically aided by MRI and CT scan together with biopsy where applicable. The MSTS score was used to evaluate the functional score of all patients. The mean follow-up was 5 years with range between 6 months to 256 months. Biological reconstruction with shoulder fusion (VF in 8 patients and PS in7 patients) was done in 15 patients (44%) while non-biological reconstruction (PMMA spacer in17 patients and endoprosthesis in 2 patients) was done in 19 patients (56%). Resections were mainly intraarticular at 82%, above 15 cm length at 65% and requiring antero-medial approach at 59%.
Radial nerve injury was only encountered in less than 2 patients (6%) while construct failure occurred in 6 patients (17%). 85% of surgically resected specimens were wide while 15 % were marginal/ intralesional. 10 cases (30%) initially presented with pathological fracture on presentation. The MSTS mean score was evaluated at 25.5 with lowest being 23 while the highest was 29.
6 patients out of 34 had local recurrence (18%). Near half of patients (41%) developed chest metastasis. The 5-year survivorship of proximal humeral osteosarcoma at Cairo University Hospitals was estimated at 65% which is slightly worse than osteosarcoma around knee and better than osteosarcoma occurs in pelvis and spine. Survivorship was significantly dependent on absence of local recurrence (P=0.014) and remarkably improved with absent chest metastasis (P<0.001). Occurrence of local recurrence was not found to be related to any variables. The noticeable variable is with regards to the deltoid resection which showed significant inverse correlation with distant metastatic spread (P=0.05).
Functional outcome was only affected by age where the younger age of patient was statistically associated with poorer MSTS score(P=0.0016). Both our main methods of reconstruction shared similar MSTS of 25 as mean score (P=1).
As conclusion, osteosarcoma of proximal humerus may present worse oncological outcome compared to Osteosarcoma around knee and better than osteosarcoma of pelvis and spine. There is no superiority of any method of reconstruction over the other.
PMMA spacer could be an affordable good method of reconstruction with almost the same functional outcome compared to endoprosthesis.