Skip metastasis in bone sarcoma. Epidemiology pronostic value and surgical incidences

Communication sur le cancer

Skip metastasis in bone sarcoma. Epidemiology pronostic value and surgical incidences
association ametist

cancer de l'enfant L'ASSOCIATION
osteosarcome enfant
   lutte contre le cancer Accueil
   associations enfants cancer Pourquoi AMETIST ?
   association ostéosarcome Ses missions
   osteosarcome enfant Unité spécialisée
   association malades ostéosarcome Spécificité de l'Unité
   association de cancereux Ses actions
   osteosarcome enfant Actualités

cancer de l'enfant SOUTIENS
osteosarcome enfant
   association cancer Personnalités
   association cancer Témoignages
   association Témoignages Vidéos
   osteosarcome enfant Sites Internet

cancer de l'enfant ILS EN PARLENT
osteosarcome enfant
   aides diverses pour cancéreux Télévision
   oncologie pédiatrique Radios
   osteosarcome enfant Presse
   aide pour le cancer Médias Internet

association enfant cancer PARTICIPER
osteosarcome enfant
   cancer de l'enfant Devenir Membre
   association enfant cancer Faire un don
   association cancers Faire un lien

sarcome de ewing AMETIST ET VOUS
   sarcome ewing Nous contacter
   sarcome cancer Lettre d'information
   sarcome cancer FaceBook AMETIST

pétition enfants cancéreux

carine curtet
Témoignage Intégral de Carine Curtet
Présidente de l'Association AMETIST

vidéo nicole delepine
Témoignage Intégral du Dr Delépine
Pour le film Cancer Business Mortel

vidéo nicole delepine
vidéo nicole delepine

soutien associaiton cancer

Si vous souhaitez contacter Nicole Delepine
Rendez-vous sur son site :
site de Nicole Delépine

information cancer et médecine

Skip metastasis in bone sarcoma. Epidemiology pronostic value and surgical incidences

Gérard Delepine, Salwah Alkhallaf, Helene Cornille, Nicole Delepine

Service d 'oncologie pédiatrique Hôpital Raymond Poincaré Garches France

CTOS London 2008 november 13-15


30 years ago Ennecking

described Skip metastases

by but till now few papers

have tried to evaluate their actual

incidence prognostic value and

surgical implications

that is the aim of this

Monocentric retrospective study


 520 patients with bone sarcoma of limbs, scapula or innominate bone

 255 OS , 135 CS, 130 EW and other

 Have been treated and/or followed up by the same team in 23 years.

 503 of these were treated by limb salvage


 Preoperative screening of patients included standard X rays, CT and bone technetium scan in all cases and MRI in 350 cases

 Diagnosis of skip was made on preoperative screening and confirmed by postoperative histologic examination

 This research was supplemented by careful examination of imaging of patients who suffered of regional relapse after surger

 Median follow up is 16 years (minimal 4) excet for 4 disease free survivors lost for follow after 3 years


 Frequency : 21 skip metastases (4%) have been observed

 12 out of 255 patients with Ostéosarcoma (5%

 8 Out 120 patients with Ewing's sarcoma (6%)

 Only one in 135 chondrosarcoma

 Most of the skip lesion were unique but 3 patients had 2 and one 3 skip

Proximal skip in osteosarcoma

Trans articular skip

Osteosarcoma of distal femur with 2 distal skip

Skip in Ewing's sarcoma

 The 6 other have been discovered on preoperative MRI of Ewing's sarcoma of innominate bone

 In half of these patients the skip lesions could not be seen on X Rays, CT and Technetium Scan

Skip metastasis unrecognized before amputation

Unrecognized skip before resection

 4 patients did not benefit of an efficient preoperative screening (no total bone MRI)

 the diagnosis of skip metastase was done only after local recurrence (one after transtibial amputation)

Consequence of skip from distal femur

Consequence of skip lesion from tibia(OS)

Femoral skip metastasis of pubic Ewing

Consequences and outcome

3 Skip from Ewing's sarcoma of tibia

 Out 130 patients with Ewing's sarcoma 8 (6%) presented with skip lesions

 6 in pelvic primary

 Two for a long bone primary

 One patient had three skips on the same knee

Consequence and outcome of solitary lumbar skip metastasis from iliac Ew

Consequences of 3 skip lesions from tibia

Unrecognised skip metastasis from tibial OS

In this patients the prognostic value of skip lesion was directly correlated with the adequacy of resection and the efficacy of the chemotherapy when chemotherapy is suboptimal or some skip not resected the prognosis is dismal

Prognostic value of skip

With our most effective protocols and when all visible lesion could be resected , the presence of skip lesions did not affect the disease free survival of our patients


Skip metastases are rare in Osteosarcoma and Ewing's

sarcoma (5%) and very rare in chondrosarcoma (1%).

Pelvic Ewing's presents a very high risk of regional skip (20%)

With effective preoperative screening and optimal

chemotherapies the skip lesions are no longer adverse prognostic


cancer Consulter le document dans sa version complète tumeur

ostéocarcome sarcome ewing

traitement sarcome ewing
Accueil | L'association | Faire un Don | Actualités | Actions | Contacts | Sarcomes | Nicole Delépine | Info cancer | Plan du site | Mentions Légales | Webangelis