Abstract
Osteosarcoma is the most common tumor among the primitive malignant bone tumors. When different features of these lesions are considered, we can find several varieties of this tumor, with distinct anatomo-clinical presentation, treatment and prognosis.
Until the 70s, its prognosis was very poor, the standard surgical treatment was amputation and 80% of the patients died from metastatic disease. With the development of new surgical techniques, the advent of combined chemotherapy and more accurate imaging, the outcome of these patients has improved significantly. Consequently, approximately 90% of the surgical cases are treated with limb salvage procedures.
The authors reviewed 22 cases of Osteosarcoma treated in HGSA, 20 being submitted to the T20 Rosen protocol.
Trocar biopsy was performed in 19 of the patients and 3 of the patients were submitted to incisional biopsy in order to complete diagnosis.
Regarding the anatomo-clinical pattern, Classic Osteosarcoma was present in 19 patients, 2 of the cases were Parosteal and 1 was Central low-grade Osteosarcoma.
The majority of patients underwent limb salvage surgery; only 2 had amputation surgery and 1 patient was submitted to palliative chemotherapy. Considering limb salvage procedures, several techniques were performed: arthrodesis (n=1), grafts (n=4), prosthesis (n=13) and compound prosthesis (n=1). The resection margins were wide in 19 cases, marginal in 2 cases and in 1 case intra-luminal.
Among the treated patients: 12 patients are still alive and cured, 3 have metastatic disease, 6 are deceased and 1 didn’t complete the follow-up.
The final functional score obtained was 84% for the superior limb (DASH) and 81% for the inferior limb (TESS).
Although the scarce number of cases described were not enough to make any kind of correlation, it was possible to establish the accuracy of the multidisciplinary approach involved both in the diagnosis and treatment, in agreement with the “state of art”.
Correspondence should be addressed to Professor Stefan Bielack, Olgahospital, Klinikum Stuttgart, Bismarkstrasse 8, D-70176 Stuttgart, Germany. Email: s.bielack@klinikum_stuttgart.de
