Download - Osteosarcoma[2]
![Page 1: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/1.jpg)
04/12/23
1
Osteosarcoma
![Page 2: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/2.jpg)
Overview2
DefinitionEpidemiologyPathogenesisSkeletal distributionClinical
presentationEvaluationHigh grade
osteosarcoma
Parosteal osteosarcoma
Periosteal osteosarcoma
High grade surface osteosarcoma
![Page 3: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/3.jpg)
Definition3
2nd most common primary bone tumor
Malignant tumor of mesenchymal origin
Spindle shaped cells that produce osteoid
![Page 4: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/4.jpg)
Epidemiology4
Any age75% 12-25yrsModal incidence
![Page 5: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/5.jpg)
Epidemiology5
Primary vs secondary
Male : female
Li Fraunie syndrome
![Page 6: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/6.jpg)
Pathogenesis6
Unknown
Modal incidence correlates with rapid bone growth
Radiation exposure
Cancer survivors
Retinoblastoma
![Page 7: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/7.jpg)
Skeletal distribution7
![Page 8: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/8.jpg)
Classification8
![Page 9: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/9.jpg)
Clinical Presentation9
Painful mass arising from bone
Trauma
Metastisize early in evolution 20% clinically detectable mets at dx
![Page 10: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/10.jpg)
Evaluation10
Suspected diagnosis by hx and physical
Supported by xray
![Page 11: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/11.jpg)
Plain Xray11
Lytic, sclerotic or mixedTypical characteristics of malignant tumorEnneking’s 4 questions
![Page 12: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/12.jpg)
Initial Evaluation12
Define the extent of the disease
Locally Systemically
![Page 13: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/13.jpg)
Local13
CT
MRI
+/- Angiogram
![Page 14: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/14.jpg)
CT14
![Page 15: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/15.jpg)
MRI15
![Page 16: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/16.jpg)
Angio16
![Page 17: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/17.jpg)
Systemic17
Bone scan CT Chestlab
![Page 18: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/18.jpg)
Classic High Grade Osteosarc18
Age, sexPresentationPhysical examBlood workPlain films
Site size
![Page 19: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/19.jpg)
Differential Dx19
Giant Cell TumorAneursymal Bone CystEwingsOsteoblastomaMetastasisLymphoma
![Page 20: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/20.jpg)
Biopsy20
Principles
Dx “high grade osteosarcoma”
Now What??
![Page 21: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/21.jpg)
Chemotherapy21
Micro metastasis
What we have learned pre chemo (1970’s)
Multi Institutional Osteosarcoma Study
![Page 22: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/22.jpg)
Chemotherapy22
Chemo cannot control clinically detectable disease
Radiation is ineffective
Local control is surgical
![Page 23: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/23.jpg)
Chemotherapy23
Best protocol is subject of ongoing trials
Drugs Doxorubicin Cisplatin Ifosfamide Methotrexate Cyclophosphamide
Side effects
![Page 24: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/24.jpg)
Induction Chemotherapy24
Arose in conjunction with development of limb sparing surgery
Increase survival
prognostic
![Page 25: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/25.jpg)
Surgery25
Limb salvage the norm
Now safer procedure
Wide surgical margin
![Page 26: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/26.jpg)
Surgical options26
Articular surface removed Osteoarticular allograft replacement Custom modular prosthesis Allograft prosthesis composite Allograft arthodesis
Segment of diaphysis missing Intercalary allograft
![Page 27: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/27.jpg)
Surgery27
Young patient with open growth plate Rotatioplasty Conventional amputation
![Page 28: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/28.jpg)
28
![Page 29: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/29.jpg)
Surgery29
Indication for amputation Grossly displaced pathologic fracture Encasement of neurovascular bundle Tumor that enlarges during preop chemo and is
adjacent to neurovascular bundle
![Page 30: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/30.jpg)
Current Standard of Care30
Pretreatment radiologic stagingBx to confirm diagnosisPreoperative chemotherapyRepeat radiologic staging
(access chemo response, finalize surgical tx plan)Surgical resection with wide marginReconstruction using one of many
technoquesPost op chemo based on preop response
![Page 31: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/31.jpg)
Surface osteosarcoma31
Parosteal
Periosteal
High grade surface osteosarcoma
![Page 32: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/32.jpg)
Parosteal32
5% of osteosarcomasPosterior metaphysis of distal femurSlow growing large ossified massConfused with osteochondromaString signLow gradetreatment
![Page 33: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/33.jpg)
Parosteal Osteosarcoma33
![Page 34: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/34.jpg)
Parosteal Osteosarcoma34
![Page 35: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/35.jpg)
Periosteal Osteosarcoma35
Arises from surface of diaphysisCharacterized by bony spicule formation
perpendicular to shaftSunburstLow grade Wide excision
![Page 36: Osteosarcoma[2]](https://reader036.vdocuments.net/reader036/viewer/2022081514/556ea62ad8b42afe778b4bf8/html5/thumbnails/36.jpg)
High grade surface36
Very rare20-30’sAppearance as parosteal but histology high
gradeTx as classic intermedullary