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.