RELAPSED OSTEOSARCOMA

CAN THERE BE A HAPPIER ENDING?

CHETAN DHAMNE

CASE 1

• 15 YEAR OLD BOY WITH RIGHT DISTAL FEMUR NON-METASTATIC

OSTEOSARCOMA S/P LIMB SALVAGE SURGERY

• 70% NECROSIS AFTER NEO-ADJUVANT CHEMOTHERAPY

• MULTIPLE EPISODES OF FEBRILE NEUTROPENIA - CULTURES POSITIVE FOR

STAPH AUREUS

• RELAPSED 17 MONTHS AFTER COMPLETION OF CHEMOTHERAPY

• SOLITARY PULMONARY NODULE

29 July 2014

27 Aug 2014

• VATS 2ND OCTOBER 2014

• NO CHEMOTHERAPY

6th Jan 2015

26 June 2015

Conclusion: Patients with recurrence of osteosarcoma presenting as

a single pulmonary nodule on CT scan were not found to have

additional lesions at the time of surgery

Ipsilateral metastases are not likely to be found at the same time.

Conclusion: Half of the patients with recurrent osteosarcoma

presenting as a single pulmonary metastasis more than 1 year

after diagnosis were long term survivors.

Metastatectomy was the primary treatment, chemotherapy did

not add benefit.

• SOLITARY NODULE NO ROLE OF CHEMOTHERAPY

• NOW 1 YEAR AFTER COMPLETION OF TREATMENT AND DOING FINE

CASE 2

• 17 YEAR OLD BOY WITH NON METASTATIC OSTEOSARCOMA OF THE

LEFT DISTAL FEMUR DIAGNOSED IN 2009

• 1ST RELAPSE JUNE 2012 MULTIPLE NODULES IN THE LEFT COSTO-

PHRENIC ANGLE

• RECEIVED 4 CYCLES OF IFOSFAMIDE ETOPOSIDE

• IN CR2 UNTIL OCTOBER 2013

9th October 2013

• PLEURODESIS 16TH OCTOBER 2013

• GEMCITABINE DOCETAXEL 2 CYCLES

7th November 2013

2nd December 2013

• DECEMBER - HICUPPS AND BACK PAIN

• LESIONS PROGRESSED ON 2 CYCLES OF GEMCITABINE AND

DOCETAXEL

7th January 2014

• JANUARY AND FEBRUARY - 2 CYCLES

• HIGH DOSE IFOSFAMIDE 14G/M2

• BACK PAIN GOT BETTER

11 March 2014

I have a dream and some unfinished business

27 June 2014

I want to see the world

CASE 3

• 14 YEAR OLD BOY WITH SYNCHRONOUS OSTEOSARCOMA LEFT

PROXIMAL TIBIA AND RIGHT SCAPULA

• 90% TUMOR NECROSIS

• UNDERWENT VAN NESS ROTATION-PLASTY

• COMPLETED TREATMENT IN AUGUST 2012

• SEPTEMBER 2013 PRESENTED WITH C/O RIGHT KNEE PAIN

20 October 2013

• 4 CYCLES OF IFOSPHAMIDE AND ETOPOSIDE WITH ZOLENDRONIC ACID

• TUMOR NECROSIS 5% IN NOVEMBER 2013

• RESECTION WITH QUESTIONABLE POSITIVE MARGINS

• GEMCITABINE DOCETAXEL

• LOCAL RADIATION 60GY

• WENT TO SCHOOL

10 February 2015

• NK CELL THERAPY

• TEMPORARY RELIEF OF PAIN

• PROGRESSION OF DISEASE

• WHAT ELSE CAN I DO?

CASE 4

• 12 YEAR OLD BOY IN OCTOBER 2011 PRESENTED WITH

PATHOLOGICAL FRACTURE

• NON METASTATIC OSTEOSARCOMA OF THE RIGHT PROXIMAL TIBIA

• UNDERWENT MEGAPROSTHESIS PLACEMENT AND EXTENSOR

APPARATUS RECONSTRUCTION

• MULTIPLE WOUND INFECTIONS

10th September 2013

• SURGERY ONLY NO CHEMOTHERAPY FOR RISK OF INFECTION OF THE

PROSTHESIS OCTOBER 2013

• JANUARY 2014 – INCREASED DRAINAGE FROM THE WOUND SITE

GREENISH DISCHARGE

• RISK OF SEPSIS

• ABOVE KNEE AMPUTATION 21ST FEBRUARY 2014

• GOOD WOUND HEALING BY MARCH 2014 – READY FOR

CHEMOTHERAPY

17th February 2014

18th March 2014

• STARTED ON THALIDOMIDE AND CELECOXIB MARCH 2014

10 September 2014

10 September 2014

10th February 2015

• APRIL 2015 ADDED SORAFENIB AND EVEROLIMUS

17th June 2015

Thank you