Diagnoses, treatment, and oncologic outcomes in patients with calcaneal malignances: Case series, systematic literature review, and pooled cohort analysis

Background and Objectives Malignant tumors of the calcaneus are rare but pose a treatment challenge. Aims: (1) describe the demographics of calcaneal malignancies in a large cohort; (2) describe survival after amputation versus limb‐salvage surgery for high‐grade tumors. Methods Study group: a “pooled” cohort of patients with primary calcaneal malignancies treated at two cancer centers (1984−2015) and systematic literature review. Kaplan−Meier analyses described survival across treatment and diagnostic groups; proportional hazards modeling assessed mortality after amputation versus limb salvage. Results A total of 131 patients (11 treated at our centers and 120 patients from 53 published studies) with a median 36‐month follow‐up were included. Diagnoses included Ewing sarcoma (41%), osteosarcoma (30%), and chondrosarcoma (17%); 5‐year survival rates were 43%, 73% (70%, high grade only), and 84% (60%, high grade only), respectively. Treatment involved amputation in 52%, limb salvage in 27%, and no surgery in 21%. There was no difference in mortality following limb salvage surgery (vs. amputation) for high‐grade tumors (HR 0.38; 95% CI 0.14−1.05), after adjusting for Ewing sarcoma diagnosis (HR 5.15; 95% CI 1.55−17.14), metastatic disease at diagnosis (HR 3.88; 95% CI 1.29−11.64), and age (per‐year HR 1.04; 95% CI 1.02−1.07). Conclusions Limb salvage is oncologically‐feasible for calcaneal malignancies.