Comparison of Clinical Outcomes Between Autologous Cryosurgery Reconstruction and Bone Cement Reconstruction in Osteosarcoma
Keywords:
Osteosarcoma; Limb Salvage Surgery; Cryosurgery; Bone Cement; MSTS Score; Relapse; Metastasis; Reconstruction Techniques
Abstract
Background: Osteosarcoma is a primary malignant bone tumor that commonly affects adolescents and young adults. Limb-salvage surgery has become a preferred approach over amputation, with various reconstruction techniques such as autologous cryosurgery and bone cement reconstruction. However, the comparative clinical outcomes of these methods remain a subject of ongoing investigation.
Objective: This study aims to compare the clinical outcomes between autologous cryosurgery reconstruction and bone cement reconstruction in osteosarcoma patients.
Methods: A retrospective cohort study with a post-test only control group design was conducted using medical records of osteosarcoma patients treated at H. Adam Malik Hospital, Medan, from January 2022 to December 2025. A total of 22 patients were included and divided into two groups: cryosurgery (n=11) and bone cement reconstruction (n=11). Clinical outcomes were evaluated using MSTS scores, relapse rates, and metastasis incidence. Statistical analysis was performed using appropriate comparative tests with a significance level of p<0.05.
Results: The results showed no statistically significant differences between the two groups in terms of MSTS scores (p=0.51), relapse rates (p=0.06), and metastasis incidence (p=0.64). Although the bone cement group demonstrated slightly higher MSTS scores, the difference was not significant. Similarly, relapse and metastasis rates were comparable between groups.
Conclusion: Autologous cryosurgery and bone cement reconstruction provide comparable functional and oncological outcomes in osteosarcoma patients undergoing limb-salvage surgery. Both methods can be considered viable reconstruction options, with selection tailored to patient condition, resource availability, and clinical considerations. Further studies with larger sample sizes and prospective designs are recommended.
References
1. Ottaviani G, Jaffe N. The epidemiology of osteosarcoma. Cancer Treat Res. 2009;152:3-13. doi:10.1007/978-1-4419-0284-9_1
2. Aksnes LH, Bauer HC, Jebsen NL, et al. Limb-sparing surgery preserves more function than amputation: a Scandinavian sarcoma group study of 118 patients. J Bone Joint Surg Br. June 2008; 90(6):786-94. doi:10.1302/0301-620X.90B6.19805
3. Simpson E, Brown HL. Understanding osteosarcomas. JAAPA. Aug. 2018; 31(8):15-19. doi:10.1097/01.JAA.0000541477.24116.8d
4. Gerrand C, Athanasou N, Brennan B, et al. UK guidelines for the management of bone sarcomas. Clin Sarcoma Res. 2016;6:7. doi:10.1186/s13569-016-0047-1
5. Mirabello L, Troisi RJ, Savage SA. International osteosarcoma incidence patterns in children and adolescents, middle ages and elderly persons. Int J Cancer. Jul 1, 2009; 125(1):229-34. doi:10.1002/ijc.24320
6. Hameed M, Mandelker D. Tumor Syndromes Predisposing to Osteosarcoma. Adv Anat Pathol. Jul 2018; 25(4):217-222. doi:10.1097/PAP.00000000000000190
7. Xin S, Wei G. Prognostic factors in osteosarcoma: A study level meta-analysis and systematic review of current practice. J Bone Oncol. Apr 2020;21:100281. doi:10.1016/j.jbo.2020.100281
8. Rickel K, Fang F, Tao J. Molecular genetics of osteosarcoma. Bone. Sep 2017;102:69-79. doi:10.1016/j.bone.2016.10.017
9. Hansen MF, Seton M, Merchant A. Osteosarcoma in Paget's disease of bone. J Bone Miner Res. Dec 2006; 21 Suppl 2:P58-63. doi:10.1359/jbmr.06s211
10. Widhe B, Widhe T. Initial symptoms and clinical features in osteosarcoma and Ewing sarcoma. J Bone Joint Surg Am. May 2000; 82(5):667-74. doi:10.2106/00004623-200005000-00007
11. Moss DW. Diagnostic aspects of alkaline phosphatase and its isoenzymes. Clin Biochem. Aug. 1987; 20(4):225-30. doi:10.1016/s0009-9120(87)80002-4
12. Fu Y, Lan T, Cai H, Lu A, Yu W. Meta-analysis of serum lactate dehydrogenase and prognosis for osteosarcoma. Medicine (Baltimore). May 2018; 97(19):e0741. doi:10.1097/MD.00000000000010741
13. Zulhendri F, Ravalia M, Kripal K, Chandrasekaran K, Fearnley J, Perera CO. Propolis in Metabolic Syndrome and Its Associated Chronic Diseases: A Narrative Review. Antioxidants (Basel). Feb 26, 2021; 10(3)doi:10.3390/antiox10030348
14. Kundu ZS. Classification, imaging, biopsy and staging of osteosarcoma. Indian J Orthop. May 2014; 48(3):238-46. doi:10.4103/0019-5413.132491
15. Huvos AG. Bone Tumors: Diagnosis, Treatment, and Prognosis. Saunders; 1991.
16. DiCaprio MR, Friedlaender GE. Malignant Bone Tumors: Limb Sparing Versus Amputation. JAAOS - Journal of the American Academy of Orthopaedic Surgeons. 2003; 11(1):25-37.
17. Davoodi SH, Yousefinejad V, Ghaderi B, et al. Oral Propolis, Nutritional Status and Quality of Life with Chemotherapy for Breast Cancer: A Randomized, Double-Blind Clinical Trial. Nutr Cancer. 2022; 74(6):2029-2037. doi:10.1080/01635581.2021.1988118
18. Darvishi N, Yousefinejad V, Akbari ME, et al. Antioxidant and anti-inflammatory effects of oral propolis in patients with breast cancer treated with chemotherapy: a Randomized controlled trial. Journal of Herbal Medicine. 2020/10/01/ 2020;23:100385. doi:https://doi.org/10.1016/j.hermed.2020.100385
19. Piredda M, Facchinetti G, Biagioli V, et al. Propolis in the prevention of oral mucositis in breast cancer patients receiving adjuvant chemotherapy: A pilot randomised controlled trial. Eur J Cancer Care. Nov 2017; 26(6)doi:10.1111/ecc.12757
20. Ebeid SA, Abd El Moneim NA, El-Benhawy SA, Hussain NG, Hussain MI. Assessment of the radioprotective effect of propolis in breast cancer patients undergoing radiotherapy. New perspective for an old honey bee product. Journal of Radiation Research and Applied Sciences. 2016/10/13/ 2016; 9(4):431-440. doi:https://doi.org/10.1016/j.jrras.2016.06.001
21. Higuchi T, Yamamoto N, Hayashi K, et al. Successful joint preservation of distal radius osteosarcoma by en bloc tumor excision and reconstruction using a tumor bearing frozen autograft: a case report. BMC Surg. Mar 1 2018; 18(1):12. doi:10.1186/s12893-018-0346-y
22. Campos E, Júnior M, Sanches D, et al. The Importance of the Multidisciplinary Approach to Surgical Treatment of Extremity Soft-Tissue Sarcomas. Journal of Cancer Therapy. 01/01 2020;11:772-784. doi:10.4236/jct.2020.1112067
23. Campanacci M, Costa P. Total resection of distal femur or proximal tibia for bone tumours. Autogenous bone grafts and arthrodesis in twenty-six cases. J Bone Joint Surg Br. Nov 1979; 61-B(4):455-63. doi:10.1302/0301-620X.61B4.227909
24. Berner K, Johannesen TB, Berner A, et al. Time-trends on incidence and survival in a nationwide and unselected cohort of patients with skeletal osteosarcoma. Acta Oncol. Jan 2015; 54(1):25-33. doi:10.3109/0284186X.2014.923934
25. Borges KS, Brassesco MS, Scrideli CA, Soares AE, Tone LG. Antiproliferative effects of Tubi-bee propolis in glioblastoma cell lines. Genet Mol Biol. Apr 2011; 34(2):310-4. doi:10.1590/s1415-47572011000200024
26. Crompton BD, Goldsby RE, Weinberg VK, Feren R, O'Donnell RJ, Ablin AR. Survival after recurrence of osteosarcoma: a 20-year experience at a single institution. Pediatr Blood Cancer. Sep 2006; 47(3):255-9. doi:10.1002/pbc.20580
27. Gelderblom H, Jinks RC, Sydes M, et al. Survival after recurrent osteosarcoma: data from 3 European Osteosarcoma Intergroup (EOI) randomized controlled trials. Eur J Cancer. Apr 2011; 47(6):895-902. doi:10.1016/j.ejca.2010.11.036
28. Ferrari S, Briccoli A, Mercuri M, et al. Postrelapse survival in osteosarcoma of the extremities: prognostic factors for long-term survival. J Clin Oncol. Feb. 15, 2003; 21(4):710-5. doi:10.1200/JCO.2003.03.141
29. Kempf-Bielack B, Bielack SS, Jürgens H, et al. Osteosarcoma relapse after combined modality therapy: an analysis of unselected patients in the Cooperative Osteosarcoma Study Group (COSS). J Clin Oncol. Jan 20, 2005; 23(3):559-68. doi:10.1200/JCO.2005.04.063
30. Kamal AF, Muhamad A. Outcomes of En bloc resection followed by reconstruction of giant cell tumor around knee and distal radius. A case series. Ann Med Surg (Lond). Jan 2020;49:61-66. doi:10.1016/j.amsu.2019.11.019
31. Rubiansyah P, Akbar MR. Early Clinical Outcome of Limb Salvage Surgery of Osteosarcoma in the Lower Extremity Using Liquid Nitrogen. Bioscientia Medicina : Journal of Biomedicine and Translational Research. 2022;
32. Gupta A, Das K, Bansal K, Singh Chhabra H, Arora M. Should Implant Breakage Be Always Considered as Implant "Failure" in Spine Surgery: Analysis of Two Cases and Literature Review. Cureus. May 25, 2021; 13(5):e15233. doi:10.7759/cureus.15233
33. Kaneuchi Y, Hakozaki M, Yamada H, et al. Very late relapse of high-grade osteosarcoma: A case report and review of the literature. Medicine (Baltimore). Jul 17, 2020; 99(29):e21206. doi:10.1097/MD.000000000000021206
34. Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: reliability, validity, and guidelines. Journal of Clinical Oncology. 1984; 2(3):187-193. doi:10.1200/jco.1984.2.3.187
35. Mirabello L, Troisi RJ, Savage SA. Osteosarcoma incidence and survival rates from 1973 to 2004. Cancer. 2009; 115(7):1531-1543. doi:https://doi.org/10.1002/cncr.24121
36. Bielack S, Carrle D, Casali PG, Group EGW. Osteosarcoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. May 2009; 20 Suppl 4:137-9. doi:10.1093/annonc/mdp154
37. Longhi A, Errani C, De Paolis M, Mercuri M, Bacci G. Primary bone osteosarcoma in the pediatric age: State of the art. Cancer Treatment Reviews. 2006; 32(6):423-436. doi:10.1016/j.ctrv.2006.05.005
38. Simon C, Bulut C, Federspil PA, et al. Assessment of peri- and postoperative complications and Karnofsky-performance status in head and neck cancer patients after radiation or chemoradiation that underwent surgery with regional or free-flap reconstruction for salvage, palliation, or to improve function. Radiat Oncol. Sep 6 2011;6:109. doi:10.1186/1748-717X-6-109
39. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. Nov-Dec 1980; (153):106-20.
40. Meller I, Weinbroum A, Bickels J, et al. Fifteen years of bone tumor cryosurgery: a single-center experience of 440 procedures and long-term follow-up. Eur J Surg Oncol. Aug. 2008; 34(8):921-927. doi:10.1016/j.ejso.2007.11.001
41. Marcove RC, Weis LD, Vaghaiwalla MR, Pearson R, Huvos AG. Cryosurgery in the treatment of giant cell tumors of bone. A report of 52 consecutive cases. Cancer. Mar 1978; 41(3):957-69. doi:10.1002/1097-0142(197803)41:3<957::aid-cncr2820410325>3.0.co; 2-y
42. Isakoff MS, Bielack SS, Meltzer P, Gorlick R. Osteosarcoma: Current Treatment and a Collaborative Pathway to Success. J Clin Oncol. Sep 20 2015; 33(27):3029-35. doi:10.1200/JCO.2014.59.4895
43. Kansara M, Teng MW, Smyth MJ, Thomas DM. Translational biology of osteosarcoma. Nat Rev Cancer. Nov 2014; 14(11):722-35. doi:10.1038/nrc3838
2. Aksnes LH, Bauer HC, Jebsen NL, et al. Limb-sparing surgery preserves more function than amputation: a Scandinavian sarcoma group study of 118 patients. J Bone Joint Surg Br. June 2008; 90(6):786-94. doi:10.1302/0301-620X.90B6.19805
3. Simpson E, Brown HL. Understanding osteosarcomas. JAAPA. Aug. 2018; 31(8):15-19. doi:10.1097/01.JAA.0000541477.24116.8d
4. Gerrand C, Athanasou N, Brennan B, et al. UK guidelines for the management of bone sarcomas. Clin Sarcoma Res. 2016;6:7. doi:10.1186/s13569-016-0047-1
5. Mirabello L, Troisi RJ, Savage SA. International osteosarcoma incidence patterns in children and adolescents, middle ages and elderly persons. Int J Cancer. Jul 1, 2009; 125(1):229-34. doi:10.1002/ijc.24320
6. Hameed M, Mandelker D. Tumor Syndromes Predisposing to Osteosarcoma. Adv Anat Pathol. Jul 2018; 25(4):217-222. doi:10.1097/PAP.00000000000000190
7. Xin S, Wei G. Prognostic factors in osteosarcoma: A study level meta-analysis and systematic review of current practice. J Bone Oncol. Apr 2020;21:100281. doi:10.1016/j.jbo.2020.100281
8. Rickel K, Fang F, Tao J. Molecular genetics of osteosarcoma. Bone. Sep 2017;102:69-79. doi:10.1016/j.bone.2016.10.017
9. Hansen MF, Seton M, Merchant A. Osteosarcoma in Paget's disease of bone. J Bone Miner Res. Dec 2006; 21 Suppl 2:P58-63. doi:10.1359/jbmr.06s211
10. Widhe B, Widhe T. Initial symptoms and clinical features in osteosarcoma and Ewing sarcoma. J Bone Joint Surg Am. May 2000; 82(5):667-74. doi:10.2106/00004623-200005000-00007
11. Moss DW. Diagnostic aspects of alkaline phosphatase and its isoenzymes. Clin Biochem. Aug. 1987; 20(4):225-30. doi:10.1016/s0009-9120(87)80002-4
12. Fu Y, Lan T, Cai H, Lu A, Yu W. Meta-analysis of serum lactate dehydrogenase and prognosis for osteosarcoma. Medicine (Baltimore). May 2018; 97(19):e0741. doi:10.1097/MD.00000000000010741
13. Zulhendri F, Ravalia M, Kripal K, Chandrasekaran K, Fearnley J, Perera CO. Propolis in Metabolic Syndrome and Its Associated Chronic Diseases: A Narrative Review. Antioxidants (Basel). Feb 26, 2021; 10(3)doi:10.3390/antiox10030348
14. Kundu ZS. Classification, imaging, biopsy and staging of osteosarcoma. Indian J Orthop. May 2014; 48(3):238-46. doi:10.4103/0019-5413.132491
15. Huvos AG. Bone Tumors: Diagnosis, Treatment, and Prognosis. Saunders; 1991.
16. DiCaprio MR, Friedlaender GE. Malignant Bone Tumors: Limb Sparing Versus Amputation. JAAOS - Journal of the American Academy of Orthopaedic Surgeons. 2003; 11(1):25-37.
17. Davoodi SH, Yousefinejad V, Ghaderi B, et al. Oral Propolis, Nutritional Status and Quality of Life with Chemotherapy for Breast Cancer: A Randomized, Double-Blind Clinical Trial. Nutr Cancer. 2022; 74(6):2029-2037. doi:10.1080/01635581.2021.1988118
18. Darvishi N, Yousefinejad V, Akbari ME, et al. Antioxidant and anti-inflammatory effects of oral propolis in patients with breast cancer treated with chemotherapy: a Randomized controlled trial. Journal of Herbal Medicine. 2020/10/01/ 2020;23:100385. doi:https://doi.org/10.1016/j.hermed.2020.100385
19. Piredda M, Facchinetti G, Biagioli V, et al. Propolis in the prevention of oral mucositis in breast cancer patients receiving adjuvant chemotherapy: A pilot randomised controlled trial. Eur J Cancer Care. Nov 2017; 26(6)doi:10.1111/ecc.12757
20. Ebeid SA, Abd El Moneim NA, El-Benhawy SA, Hussain NG, Hussain MI. Assessment of the radioprotective effect of propolis in breast cancer patients undergoing radiotherapy. New perspective for an old honey bee product. Journal of Radiation Research and Applied Sciences. 2016/10/13/ 2016; 9(4):431-440. doi:https://doi.org/10.1016/j.jrras.2016.06.001
21. Higuchi T, Yamamoto N, Hayashi K, et al. Successful joint preservation of distal radius osteosarcoma by en bloc tumor excision and reconstruction using a tumor bearing frozen autograft: a case report. BMC Surg. Mar 1 2018; 18(1):12. doi:10.1186/s12893-018-0346-y
22. Campos E, Júnior M, Sanches D, et al. The Importance of the Multidisciplinary Approach to Surgical Treatment of Extremity Soft-Tissue Sarcomas. Journal of Cancer Therapy. 01/01 2020;11:772-784. doi:10.4236/jct.2020.1112067
23. Campanacci M, Costa P. Total resection of distal femur or proximal tibia for bone tumours. Autogenous bone grafts and arthrodesis in twenty-six cases. J Bone Joint Surg Br. Nov 1979; 61-B(4):455-63. doi:10.1302/0301-620X.61B4.227909
24. Berner K, Johannesen TB, Berner A, et al. Time-trends on incidence and survival in a nationwide and unselected cohort of patients with skeletal osteosarcoma. Acta Oncol. Jan 2015; 54(1):25-33. doi:10.3109/0284186X.2014.923934
25. Borges KS, Brassesco MS, Scrideli CA, Soares AE, Tone LG. Antiproliferative effects of Tubi-bee propolis in glioblastoma cell lines. Genet Mol Biol. Apr 2011; 34(2):310-4. doi:10.1590/s1415-47572011000200024
26. Crompton BD, Goldsby RE, Weinberg VK, Feren R, O'Donnell RJ, Ablin AR. Survival after recurrence of osteosarcoma: a 20-year experience at a single institution. Pediatr Blood Cancer. Sep 2006; 47(3):255-9. doi:10.1002/pbc.20580
27. Gelderblom H, Jinks RC, Sydes M, et al. Survival after recurrent osteosarcoma: data from 3 European Osteosarcoma Intergroup (EOI) randomized controlled trials. Eur J Cancer. Apr 2011; 47(6):895-902. doi:10.1016/j.ejca.2010.11.036
28. Ferrari S, Briccoli A, Mercuri M, et al. Postrelapse survival in osteosarcoma of the extremities: prognostic factors for long-term survival. J Clin Oncol. Feb. 15, 2003; 21(4):710-5. doi:10.1200/JCO.2003.03.141
29. Kempf-Bielack B, Bielack SS, Jürgens H, et al. Osteosarcoma relapse after combined modality therapy: an analysis of unselected patients in the Cooperative Osteosarcoma Study Group (COSS). J Clin Oncol. Jan 20, 2005; 23(3):559-68. doi:10.1200/JCO.2005.04.063
30. Kamal AF, Muhamad A. Outcomes of En bloc resection followed by reconstruction of giant cell tumor around knee and distal radius. A case series. Ann Med Surg (Lond). Jan 2020;49:61-66. doi:10.1016/j.amsu.2019.11.019
31. Rubiansyah P, Akbar MR. Early Clinical Outcome of Limb Salvage Surgery of Osteosarcoma in the Lower Extremity Using Liquid Nitrogen. Bioscientia Medicina : Journal of Biomedicine and Translational Research. 2022;
32. Gupta A, Das K, Bansal K, Singh Chhabra H, Arora M. Should Implant Breakage Be Always Considered as Implant "Failure" in Spine Surgery: Analysis of Two Cases and Literature Review. Cureus. May 25, 2021; 13(5):e15233. doi:10.7759/cureus.15233
33. Kaneuchi Y, Hakozaki M, Yamada H, et al. Very late relapse of high-grade osteosarcoma: A case report and review of the literature. Medicine (Baltimore). Jul 17, 2020; 99(29):e21206. doi:10.1097/MD.000000000000021206
34. Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: reliability, validity, and guidelines. Journal of Clinical Oncology. 1984; 2(3):187-193. doi:10.1200/jco.1984.2.3.187
35. Mirabello L, Troisi RJ, Savage SA. Osteosarcoma incidence and survival rates from 1973 to 2004. Cancer. 2009; 115(7):1531-1543. doi:https://doi.org/10.1002/cncr.24121
36. Bielack S, Carrle D, Casali PG, Group EGW. Osteosarcoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. May 2009; 20 Suppl 4:137-9. doi:10.1093/annonc/mdp154
37. Longhi A, Errani C, De Paolis M, Mercuri M, Bacci G. Primary bone osteosarcoma in the pediatric age: State of the art. Cancer Treatment Reviews. 2006; 32(6):423-436. doi:10.1016/j.ctrv.2006.05.005
38. Simon C, Bulut C, Federspil PA, et al. Assessment of peri- and postoperative complications and Karnofsky-performance status in head and neck cancer patients after radiation or chemoradiation that underwent surgery with regional or free-flap reconstruction for salvage, palliation, or to improve function. Radiat Oncol. Sep 6 2011;6:109. doi:10.1186/1748-717X-6-109
39. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. Nov-Dec 1980; (153):106-20.
40. Meller I, Weinbroum A, Bickels J, et al. Fifteen years of bone tumor cryosurgery: a single-center experience of 440 procedures and long-term follow-up. Eur J Surg Oncol. Aug. 2008; 34(8):921-927. doi:10.1016/j.ejso.2007.11.001
41. Marcove RC, Weis LD, Vaghaiwalla MR, Pearson R, Huvos AG. Cryosurgery in the treatment of giant cell tumors of bone. A report of 52 consecutive cases. Cancer. Mar 1978; 41(3):957-69. doi:10.1002/1097-0142(197803)41:3<957::aid-cncr2820410325>3.0.co; 2-y
42. Isakoff MS, Bielack SS, Meltzer P, Gorlick R. Osteosarcoma: Current Treatment and a Collaborative Pathway to Success. J Clin Oncol. Sep 20 2015; 33(27):3029-35. doi:10.1200/JCO.2014.59.4895
43. Kansara M, Teng MW, Smyth MJ, Thomas DM. Translational biology of osteosarcoma. Nat Rev Cancer. Nov 2014; 14(11):722-35. doi:10.1038/nrc3838
Published
2026-04-30
How to Cite
Irvan, Andriandi, & Aga Shahri Putera Ketaren. (2026). Comparison of Clinical Outcomes Between Autologous Cryosurgery Reconstruction and Bone Cement Reconstruction in Osteosarcoma. International Journal of Health, Economics, and Social Sciences (IJHESS), 8(2), 1690~1695. https://doi.org/10.56338/ijhess.v8i2.10932
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