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Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 66 - 66
1 Mar 2010
Bhumbra R Welck M Pearce P Cannon S
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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.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_13 | Pages 94 - 94
1 Dec 2022
Lazarides A Novak R Burke Z Gundavda M Ghert M Rose P Houdek M Wunder JS Ferguson P Griffin A Tsoi K
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Radiation induced sarcoma of bone is a rare but challenging disease process associated with a poor prognosis. To date, series are limited by small patient numbers; data to inform prognosis and the optimal management for these patients is needed. We hypothesized that patients with radiation-induced pelvic bone sarcomas would have worse surgical, oncologic, and functional outcomes than patients diagnosed with primary pelvic bone sarcomas. This was a multi-institution, comparative cohort analysis. A retrospective chart review was performed of all patients diagnosed with a radiation-induced pelvic and sacral bone sarcoma between January 1st, 1985 and January 1st, 2020 (defined as a histologically confirmed bone sarcoma of the pelvis in a previously irradiated field with a minimum 3-year interval between radiation and sarcoma diagnosis). We also identified a comparison group including all patients diagnosed with a primary pelvic osteosarcoma/spindle cell sarcoma of bone (i.e. eligible for osteosarcoma-type chemotherapy) during the same time interval. The primary outcome measure was disease-free and overall survival. We identified 85 patients with primary osteosarcoma of the pelvis (POP) and 39 patients with confirmed radiation induced sarcoma of the bony pelvis (RISB) undergoing surgical resection. Patients with RISB were older than patients with POP (50.5 years vs. 36.5 years, p67.7% of patients with POP underwent limb salvage as compared to 77% of patients with RISB; the type of surgery was not different between groups (p=.0.24). There was no difference in the rate of margin positive surgery for RISB vs. POP (21.1% vs. 14.1%, p=0.16). For patients undergoing surgical resection, the rate of surgical complications was high, with more RISB patients experiencing complications (79.5%) than POP patients (64.7%); this approached statistical significance (p=0.09). 15.4% of patients with RISB died perioperative period (within 90 days of surgery) as compared to 3.5% of patients with POP (p= 0.02). For patients undergoing surgical resection, 5-year OS was significantly worse for patients with RISB vs. POP (27.3% vs. 47.7%, p=0.02). When considering only patients without metastatic disease at presentation, a significant difference in 5-year survival remains for patients with RISB vs. POP (28.6% vs. 50%, p=0.03) was a trend towards poorer 5-year DFS for patients with RISB vs. POP (30% vs. 47.5%), though this did not achieve statistical significance (p=0.09). POP and RISB represent challenging disease processes and the oncologic outcomes are similarly poor between the two; however, the disease course for patients with RISB appears to be worse overall. While surgery can result in a favorable outcome for a small subset of patients, surgical treatment is fraught with complications


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 400 - 400
1 Jul 2008
McNair CJ Hamilton R Boddie DE Kelly I
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Aim: To review the prognosis of Pelvic Osteosarcoma in the files of the Scottish Bone Tumour Registry between 1955 and 2001. Text: The cases of 40 consecutive patients with osteosarcoma of the pelvic ossea registered in the files of the Scottish Bone Tumour Registry between 1955 and 2001 were reviewed. 6 of these patients had underlying Paget’s disease and 2 had received previous radiotherapy to the pelvis. The median age at diagnosis was 60 years (mean 55.7 years). 12 patients had distant metastases at initial presentation (Enneking stage III). 24 patients had stage IIB ostesarcomas, 3 patients had stage IIA osteosarcomas and 1 patient had stage IB osteosarcoma. The median survival of stage IIB and stage III ostesarcoma was 9.5 months (1–39 months) and 5.5 months (0.5–16 months) respectively. The median age of survival for stage IIB tumours treated prior to the introduction of chemotherapy was 9 months (1–30 months) compared to those whose treatment included chemotherapy of 12 months (4–39 months). 5 of the 40 patients treatment regimens included surgical intervention- all had stage IIB tumours. The median survival for this group was 13 months (4–39 months). Conclusion: Despite the introduction of modern multimodality treatment regimens the prognosis for pelvic osteosarcoma remains poor


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 401 - 401
1 Jul 2008
Hamilton SW MacDuff E Boddie DE Scotland TR Reid R
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Purpose: To evaluate the clinico-pathological features and outcome of osteosarcoma in patients over the age of 40 in Scotland. Methods: A retrospective review was performed using data collected by the Scottish Bone Tumour Registry on patients diagnosed with osteosarcoma over the age of 40 between 1960 and 2004. Information about tumour location, age of diagnosis, gender, lung metastasis, and survival was analysed. Histological slides were reviewed again and the diagnosis of osteosarcoma confirmed. The overall survival was calculated using Kaplan-Meier survival curves. Results: 145 patients were identified. 78 patients had malignant change in pre-existing Paget’s disease. 60 patients had osteosarcoma and 18 malignant fibrous histiocytoma. Average age of diagnosis of Paget’s osteosarcoma was 67.8 years, male to female ratio of 2:1 and 27% of cases were within the pelvis. Median survival was 6 months. 30% had lung metastasis at presentation. 54 patients had conventional osteosarcoma. Average age of diagnosis of 58.8 years, male to female ratio of 3:2 and 37% were femoral. Median survival was 11 months. 13 patients had radiation-induced osteosarcoma. Average age of diagnosis of 67.2, male to female ratio of 1:6 and 5 out of the 13 had pelvic osteosarcoma. Median survival was 8 months. Conclusion: We present the clinico-pathological features and outcome of osteosarcoma in patients over the age of 40 in Scotland between 1960 and 2004. Pelvic disease and metastasis at presentation were prevalent in patients with Paget’s and radiation-induced osteosarcoma reflecting their poor outcome


Bone & Joint 360
Vol. 7, Issue 5 | Pages 30 - 33
1 Oct 2018


Bone & Joint 360
Vol. 7, Issue 6 | Pages 33 - 35
1 Dec 2018


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_II | Pages 106 - 106
1 Apr 2005
Babinet A Milet A Laurence V Pierga J Tomeno B Anract P
Full Access

Purpose: The purpose of this work was to analyse and compare survival in patients with osteosarcoma (OS) or Ewing sarcoma (EW) of the pelvis as a function of treatment. Material and methods: This retrospective series included 31 patients with OS (n=15) or EW (n=16) of the pelvis who were given a homogeneous therapeutic sequence associating chemotherapy, surgery and/or radiotherapy. Mean follow-up was 37 months (2–144). Mean age was 20 years for EW and 28 years for OS. Localisations in the pelvis were: zone I (n=12), zone I and II (n=4), zone II (n=1), zone II and III (n=7), zone III (n=1), and zone I, II and III (n=6). All patients were given chemotherapy, 15 underwent surgery, and 16 were given radiotherapy alone. Five patients were given complementary radiotherapy after surgery. Actuarial survival curves were compared with the logrank test. Comparison factors were presence of surgical resection, presence of initial or secondary metastasis, tumour response (radiographic measure), and pathology (good or poor responder) after chemotherapy. Results: Five-year survival rate for patients with EW was 53%, 31% for OS. There was no significant difference in survival rates between tumour type. The only factor significantly correlated with lower survival rate was presence of initial metastasis. Discussion and conclusion : The pelvic localisation of osteosarcoma and Ewing sarcoma is a factor of poor prognosis. Unlike data reported in the literature, surgery did not appear to influence outcome, not being found to be a factor of better prognosis. Surgery does however appear to improve short-term survival. In the pelvic localisation, osteosarcoma appears to have a poorer prognosis in terms of survival than Ewing tumour


Bone & Joint 360
Vol. 1, Issue 3 | Pages 26 - 28
1 Jun 2012

The June 2012 Oncology Roundup360 looks at: avoiding pelvic hemipelvectomy; proximal femoral metastasis; extendible prostheses; rotationplasty; soft-tissue sarcomas; osteosarcoma of the pelvis; recurrent chondrosarcoma ; MRI and the differentiation between benign and malignant lesions; and malignant fibrous histiocytoma.