Publié sur : Power point Nicole Delépine - emsos 2003 - 2002
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Treatment of advanced pelvic osteosarcoma with chemotherapy directly inside the tumor. Case report.
G. Delepine, S. Alkallaf, B. Markowska, H. Cornille, I.M. Bigirimana, Nicole Delepine

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Treatment of advanced pelvic osteosarcoma with chemotherapy directly inside de tumor. Case report.

Introduction

Very large tumors of pelvis may seem inoperable and are often treated by palliative radiotherapy and chemotherapy.

We present here a case with intratumoral chemotherapy and mid-term result.

Case Report

This girl, 16 years old, came from Africa in 2000 July, for a huge tumor of pelvis after 2 years of pelvic pain.
A needle biopsy confirmed the diagnosis of high-grade osteosarcoma.
Initial screening showed a huge tumor (15 cm x 12 x 10) developed from the right acetabulum, with compression of bladder and both ureters.

The dilatation of kidney cavities led to perform a bilateral ureterostomy.

Conventional chemotherapy didn't obtain any response and the patient was sent in a palliative care unit after 2 months of an ineffective treatment.

In October 2000, she was referred for treatment in our unit.
We started by intratumoral debulking and put inside the tumor cavity a chemotherapy infusion catheter.

Following 3 courses of intratumoral chemotherapy (CDDP 25 mg) associated with systemic chemotherapy, new debulking surgery was performed and the normal urinary tract could be repaired.

Both intra-tumor and intravenous chemotherapy were continued and in October 2001, the last tumor residual was removed and a composite acetabular reconstruction performed.

Results

In January 2002, the patient is in complete remission. She can walk, go to school and live normally.
The hip function rate according to Ennecking's criteria is excellent.

Conclusion

Advanced sarcoma can sometimes benefit of an individualized treatment including intratumoral chemotherapy.

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