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High value of initial management in localized osteosarcoma

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High value of initial management in localized osteosarcoma
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High value of initial management in localized osteosarcoma.

A monocentric retrospective analysis.

Delepine N., Alkhallaf S, Delepine G.

Oncologic Paediatric Unit. Raymond poincaré University Hospital 92380 Garches- France -

EFORT 2008 Nice du 29 au 31 mai 2008



Introduction

 Many reports attempt to identify the factors which may affect the prognosis in osteosarcoma.

 We wanted to determine whether the prognostic value technique of biopsy and/or the initial management could be a prognostic factor of long term survival and long term local recurrence risk

Patients

 139 patients (88 males and 51 females aged 4-58 years) with localized high grade osteosarcoma of the limbs were treated and/or followed up by our team between 1984 and 1998.

Patients

Initial management

 55 patients had the biopsy performed by the surgeon of the team after local evaluation of the tumor and planning of future en bloc resection.

 84 other patients were referred to us after biopsy or/and induction therapy. No significant differences in initial prognosis factors were observed between the two groups

55 patients had the biopsy performed by the surgeon of the team

 after local evaluation of the tumor and planning of future en bloc resection.



 Excisional contaminated biopsy

 Haematoma

 infection

3 patients were primarily amputated

 all in referred patients

 among them 2 seen after inadapted biopsy

Local treatment

 All the 136 others were treated by limb salvage even for

 fractured or

 huge tumors

 or in very young patients

Method

 All patients received preoperative and postoperative chemotherapy according to the current protocols at the time of their treatment.

 All patients were followed up by their surgeon and their chemotherapist every 3 months during 2 years, then every 6 months for 2 other years and yearly thereafter.

Results : Local control

 With a median follow up of 15 years (maximal 23 - minimal 10)

- 13 local recurrences were observed : 11/84 (13 %) in referred patients and

- 2/75 (2.6 %) in first hand patients.

Survival





Conclusion 1

 Initial management by an experimented team is of crucial importance in long term survival of patients with localized high grade osteosarcoma of the limb..



Conclusion 2

 When the diagnosis of osteosarcoma can not be excluded on prebiopsy medical imaging of bone tumor, the patient should be referred, before biopsy, to team experimented in bone tumor oncology.





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