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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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