Does amputation offer any survival benefit over limb salvage in XXXX @entity1 with poor chemonecrosis and close margins?

@entity1 @entity421 @entity4218 @entity39
A poor response to chemotherapy ( <= 90% @entity39 ) for @entity421 leads to poorer survival and an increased risk of local recurrence, particularly if there is a close margin of excision. We evaluated whether amputation confers any survival benefit over @entity4218 ( @entity4218 ) with narrow margins in @entity1 who respond poorly to chemotherapy. We only analysed @entity1 with an @entity421 of the limb, a poor response to chemotherapy and close margins on @entity4218 (marginal/intralesional) or primary amputation: 360 @entity1 (36 @entity4218 (intralesional margins), 197 @entity4218 (marginal margins) and 127 amputations) were included. Local recurrence developed in 13 (36%) following @entity4218 with intralesional margins, and 39 (20%) following @entity4218 with marginal margins. There was no local recurrence in @entity1 who underwent amputation. The five-year survival for all @entity1 was 41% (95% confidence interval (CI) 35 to 46), but for those treated by @entity4218 with marginal margins was 46.2% (95% CI 38 to 53), 36.3% (95% CI 27 to 45) for those treated by amputation, and 28% (95 CI 14 to 44) for those treated by @entity4218 with intralesional margins. @entity1 who had @entity4218 and then developed local recurrence as a first event had the same survival as those who had primary amputation without local recurrence. Prophylactic adjuvant radiotherapy was used in 40 @entity1 but had no discernible effect in preventing local recurrence. Although amputation offered better local control, it conferred no clear survival benefit over @entity4218 with marginal margins in these @entity1 with a poor overall prognosis. Cite this article: Bone Joint J 2015;97-B:115-20.
