Aim: To determine the value of the Pirani clubfoot-scoring system at initial presentation in predicting subsequent relapse. Method: All clubfoot patients treated by one surgeon from 2002 to 2006 were included. Treatment followed the standard protocol, involving weekly stretching and casting until the foot was corrected, followed by Achilles tenotomy and plasters for 3 weeks. Thereafter, the child was placed in a foot abduction splint. Relapses within 6 months of instigating the foot abduction splint were classed as early and subsequent relapses as late. The severity of clubfoot was assessed using the Pirani scoring system which comprises two sub-scores – Midfoot Contracture Score (MFCS) and Hindfoot Contracture Score (HFCS). MFCS and HFCS can each be 0.0–3.0, giving rise to a Total Pirani Score (TPS) of 0.0–6.0. Results: Sixty-one clubfoot patients were treated, with five lost to the follow-up. A total of 89 clubfeet were treated. There were 3 early and 19 late relapses. The average interval between initiating the foot abduction splint and late relapse was 23 months. TPS median was 4.5 in the no relapse group, 4.0 in the early relapse group, and 5.0 in the late relapse group. MFCS median was 2.0 in the no relapse group, 2.0 in the early relapse group, and 2.0 in late relapse group. HFCS median was 2.5 in the no relapse group, 2.5 in the early relapse group, and 3.0 in the late relapse group. Higher HFCS was statistically significant when comparing the late and no relapse groups (p< 0.05, 95% CI −0.5–0.0). Conclusions: Higher Pirani scores were associated with late relapses, but HFCS is a stronger predictor of potential late relapse. Close follow-up is advised for patients at risk

Aim. Ten years ago at the EMSOS 2000 meeting we have presented our experience concerning the non-surgical treatment of stage IIB osteosarcoma of extremities. The purpose of study was to evaluate long-term results and complications related to this non-standard and controversial treatment modality. Methods. Since 1988 definitive radiation gamma therapy (RT) in the median dose of 60 Gy was administrated to 36 patients who refused surgery after preoperative chemotherapy. Until 1999 induction consisted in 3-5 cycles of intra-arterial doxorubicin (DOX) 75 mg/m2 or cis-platin (CDDP) 120 mg/m2. Since 2000 induction comprised 4 cycles of DOX 90 mg/m2+CDDP 120 mg/m2 intra-arterially. Tumour response before local treatment was assessed non-invasively by means of X-ray, CT, MRI, angiography, 3-phase bone scans and alkaline phosphatase measurement. The end-points were overall (OS), metastases free (MFS) and local progression free (LPFS) survival at 10 years. Results. OS, MFS and LPFS by Kaplan-Meier method were 48±9%, 51±9%, and 45±11% respectively. The outcome was significantly related to response assessed before RT. In 12 good responders OS, MFS and LPFS were 74±13%, 91±9%, and 69±19% respectively compared with 29±11%, 27±11%, and 34±13% in 24 non-responders, p- value 0.03, 0.003, 0.009, respectively. In 14 patients 5 years survival after local progression and delayed surgery was 38±10%. Median survival time after local relapse was 36 months. Two types of major complications were seen: 7 pathological fractures and one osteomyelitis. 21 patients (58%) remained with a functional limb until the last examination or death. Conclusions. Long-term results were higher than expected in this radioresistant tumour. In good responders to induction chemotherapy RT could be an option for local treatment. Majority of patients had a functional limb during and long time after treatment. Isolated late local relapses did not influence considerably systemic control