Abstract
Survival of patients with high-grade osteosarcoma has significantly improved with combined multi-agent chemotherapy and aggressive local surgical control. However, despite modern therapy, approximately one-third recur and those that do recur are difficult to treat successfully. The recurrence of osteosarcoma is rare. Local recurrence occurs in 4–10% of patients following effective treatment.
This report details a lady with local recurrence of osteosarcoma seventeen years following initial presentation. She was diagnosed with an osteosarcoma with both chondroblastic and osteoblastic differentiation of the right ilium in November 1989 (aged 41). There were no distant metastases. She received one cycle of neo-adjuvant chemotherapy (PIA) prior to a right hemipelvectomy in April 1990. Six weeks post excision, she underwent a hemipelvic and proximal femoral replacement. She received 5 cycles of adjuvant (PIA) chemotherapy. Post-operative recovery was complicated by infection leading to formation of a discharging sinus. Despite exploration and an external oblique rotation graft, the sinus continued to discharge and the femoral and pelvic prostheses were removed in March 1994.
She mobilised with the use of two crutches and functioned extremely well. She was not keen for reinsertion of a prosthesis and remained on yearly follow-up until 2000.
In June 2007, she presented to her general practitioner with dull right iliac fossa pain. She was referred back to our service and examination revealed a mass in the right iliac fossa. This was biopsied and demonstrated locally recurrent osteosarcoma. Staging investigations revealed no metastatic disease.
She had excision of the osteosarcoma in September 2007 followed by re-excision local re-recurrence within psoas in April 2008. To our knowledge, this is the first time that locally recurrent intramedullary osteosarcoma, 17 years from initial diagnosis and treatment, is described in the literature. This case serves as a useful clinical reminder.
Correspondence should be addressed to BOOS c/o British Orthopaedic Association, 35-43 Lincoln’s Inn Fields, London WC2A 3PE, England
