Local recurrence rates following primary resection of a malignant or aggressive bone tumor vary and depend on tumor grade and histology. Local recurrence rates of bone sarcomas are reported to be approximately 10% to 15% in patients with osteosarcoma and Ewing sarcoma [58-61]. Prognosis is poor for locally recurrent malignant or aggressive bone tumors, with postrecurrence 5-year survival rates reported approximately 15% to 30% in patients with osteosarcoma and 5% in patients with Ewing sarcoma [60,62]. Factors associated with poorer prognosis in patients with osteosarcoma were size of local recurrence (>5 cm) and presence of distant metastasis [60]. Recommendations for local recurrence surveillance imaging vary amongst expert guidelines, although all acknowledge the benefit of clinical evaluation. Locally recurrent bone tumors can often present as a soft tissue mass, and in a study of osteosarcoma local recurrences, the majority (approximately 75%) were soft tissue masses rather than bone lesions [60]. Some guidelines recommend clinical examination to be performed solely, whereas others recommend in combination with imaging [49,51,52,63]. Time to recurrence also varies with tumor histology. Most osteosarcoma local recurrences have been shown to occur within 5 years of resection. However, late recurrence of both osteosarcoma and Ewing sarcoma have been reported [60,61]. In a study of locally recurrent osteosarcoma, survival rates decreased from 30% at 5 years to 13% at 10 years, suggesting long-term follow-up beyond 5 years is beneficial. Tumor histology, grade, and clinical scenario remain paramount when deciding how to surveil for local recurrence. Bone Scan Whole Body Historically, bone scans have been used for the surveillance of local recurrence.
Malignant or Aggressive Primary Musculoskeletal Tumor Staging And Surveillance PCAs. Local recurrence rates following primary resection of a malignant or aggressive bone tumor vary and depend on tumor grade and histology. Local recurrence rates of bone sarcomas are reported to be approximately 10% to 15% in patients with osteosarcoma and Ewing sarcoma [58-61]. Prognosis is poor for locally recurrent malignant or aggressive bone tumors, with postrecurrence 5-year survival rates reported approximately 15% to 30% in patients with osteosarcoma and 5% in patients with Ewing sarcoma [60,62]. Factors associated with poorer prognosis in patients with osteosarcoma were size of local recurrence (>5 cm) and presence of distant metastasis [60]. Recommendations for local recurrence surveillance imaging vary amongst expert guidelines, although all acknowledge the benefit of clinical evaluation. Locally recurrent bone tumors can often present as a soft tissue mass, and in a study of osteosarcoma local recurrences, the majority (approximately 75%) were soft tissue masses rather than bone lesions [60]. Some guidelines recommend clinical examination to be performed solely, whereas others recommend in combination with imaging [49,51,52,63]. Time to recurrence also varies with tumor histology. Most osteosarcoma local recurrences have been shown to occur within 5 years of resection. However, late recurrence of both osteosarcoma and Ewing sarcoma have been reported [60,61]. In a study of locally recurrent osteosarcoma, survival rates decreased from 30% at 5 years to 13% at 10 years, suggesting long-term follow-up beyond 5 years is beneficial. Tumor histology, grade, and clinical scenario remain paramount when deciding how to surveil for local recurrence. Bone Scan Whole Body Historically, bone scans have been used for the surveillance of local recurrence.