Publication de Nicole Delepine : Multicentric osteosarcoma (27 years follow-up)

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Publié sur : Power point Nicole Delépine - 2005
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Multicentric osteosarcoma (27 years follow-up)
G. Delépine, F. Delepine, B. Markowska, A. Tabbi, Nicole Delépine

Multicentric osteosarcoma (27 years follow-up)



Background


In the international litterature, multifocal osteosarcoma is usually considered as uncurable and receives only palliative treatment.

our case with a very long follow-up proves that curable attitude is mandatory.

June 1984


A 11y old girl was seen in a cancer center for a huge lytic inferior femoral tumor.
Doctors consider her as condamned and propose a desarticulation for 3 months parents give only alternative medicine to her daughter, refusing amputation.
But increasing of the tumor with enormeous limb and inacceptable pain led to consult in our institution.

First clinical examination in our center, august 1984


tumor with enormeous limb

Huge, warm, femoral tumor with invasion of all muscular composants of the inferior thigh, femur seemed fractured.

Huge tumor invading fast the totality of the thigh


tumor invading

Histology : telangiectasic osteosarcoma.

Examination of total body shows two locations on the tibia (same leg)


tumor invading


Induction by combinated chemotherapy


combinated chemotherapy

- high dose Methotrexate
- Cisplatine
- Adriamycine
followed by en-bloc resection of femoral location and superior tibial one performed together.

2 months later, following a sequence of chemotherapy


chemotherapy

Inferior tibial metastasis was resected with reconstruction by bank allograft and arthrodesis of ankle.

Evolution


Protocol of chemotherapy was completed.
The patient is in first complete remission.
Numerous orthopeadic procedures were needed for lenghthening and egalising legs and for intercurrent orthopaedic complications.

Results


Follow-up 27 years, this patient is free of disease in first remission with her leg.
She works an urgentist doctor.

In the litterature


A few other cases of multifocal cured osteosarcoma were found.
The follow-up of our case is the longest.

This case demonstrates:


Multifocal osteosarcoma is curable with an effective chemotherapy protocol and systematic en-bloc resection of all bone locations.
Even in this situation amputation can be avoided.
It confirms that multifocal osteosarcoma must receive the same curative protocols as monofocal.



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