Uploaded byVenkatesan Amirthalingam
Osteosarcoma an overview
Osteosarcoma is the second most common primary bone malignancy that typically affects children and young adults. It arises from primitive bone-forming mesenchymal cells and is characterized by the production of osteoid tissue by malignant proliferating cells. The most common sites are the metaphysis of long bones like the femur. Treatment involves neoadjuvant chemotherapy, surgical resection with limb salvage when possible, and additional adjuvant chemotherapy. Prognostic factors include age, tumor size, location, and presence of metastases at diagnosis. Five-year survival has improved to over 70% with current multimodal treatment approaches.
More Related Content
Similar to Osteosarcoma an overview
Osteosarcoma an overview
- 1. Osteosarcoma Presenter – Dr.Venkatesan A Moderator – Prof. Th. Tomcha Singh
- 2. Introduction • Derived fromprimitive bone forming mesenchyme & characterized by production of osteoid tissue or immature bone by malignant proliferating spindle cell stroma • 2nd m.c primary malig. tumor of bone • 20% of primary malig. of bone • Incidence 1 – 3 / million per year • 61% - 10 – 20 yrs age • M : F – 1.6 : 1
- 3. Osteosarcoma location &site • Location Metaphysis – 90% Diaphysis – 9% Epiphysis – 1% • Site Femur – 52% Tibia – 20% Humerus – 9%
- 4. Etiology • Radiation exposure •Rx with alkylating agents • In elderly - Paget’s disease - multiple hereditary exostosis - polyostotic fibrous dysplasia • Hereditary disorders - RB - Li – Fraumeni syndrome - Rothmund Thomson syndrome
- 5. Pathology • Gross pathology i.large tumor with destruction of cortex ii. Variable consistency iii. 90% exhibit – codman’s triangle, sunburst app, etc
- 6. Histology • Histologic subtypes i. Fibroblastic ii. Chondroblastic iii. Osteoblastic iv. Telengiectactic v. small cell
- 7. Classification A. CENTRAL 1. Primaryor idiopathic 2. Secondary B. JUXTA – CORTICAL i. Paraosteal ii. Periosteal iii. High grade surface iv. Dedifferentiated paraosteal
- 8. Clinical features • Pain •Swelling • Occasional pyrexia • Pathologic fracture • Pulmonary mets symptoms
- 9. Work up • History •Physical examn • Routine lab tests • Sr. ALP • X ray • CT scan • MRI • Angiography • Bone scan • Biopsy
- 10. Work up –contd… CT Scan MRI scan
- 11. Mode of spread •Local spread • Hematogenous spread - Approx. 15% dist mets at diagnosis - > 80% pulmonary - Other bony sites • Lymphatic spread - rare
- 12.
- 13.
- 14. Prognostic factors • Age,localisation, size and initial metastatic disease • most imp. predictor of outcome at diagnosis - - ± metastases. • most reliable prognostic factor - histological response to pre-operative chemotherapy (Huvos)
- 15. Treatment modalities • Surgery •Chemotherapy • Radiotherapy
- 16. Rx – NCCNGuidelines s u r v e i l l a n c e
- 17.
- 18. Rx – NCCNGuidelines
- 19. SURGERY • Amputation • Limbsalvage procedures GUIDELINES FOR LIMB – SPARING RESECTION i. No major neurovascular involvement ii. Wide resection with normal mucsle cuff iii. EN bloc removal of biopsy sites iv. Resection 3-4cm beyond uptake v. Adj. jt resection vi. Adequate motor reconstruction
- 20. Limb salvage surgery Rxby anatomical site • Distal femur • Proximal tibia • Proximal humerus • scapula
- 21. Surgery – contd… •Pelvis & proximal femur - Hemipelvectomy • Surgical Rx of mets • Expandable prothesis in children
- 22. First line therapy(Primary/Neoadjuvant/Adjuvant ) - Cisplatin and doxorubicin/Dactinomycin - MAP (High-dose methotrexate, cisplatin, and doxorubicin) - Doxorubicin, cisplatin, ifosfamide and HDMTX( T-20) - Ifosfamide and etoposide - Ifosfamide, cisplatin and epirubicin Second line therapy (Relapsed or Refractory disease) - Docetaxel and gemcitabine - Cyclophosphamide and etoposide - Ifosfamide and etoposide - Ifosfamide, carboplatin and etoposide - HDMTX, etoposide and ifosfamide - Samarium-153 ethylene diamine tetramethylene phosphonate Current systemic therapy NCCN 2011
- 23. Assessment of histologicresponse to CT Huvos grading system
- 24. Restaging after Neoadj CT • Clinical evaluation • Plain radiography • Angiography • CT scan • Bone scintigraphy • MRI • PET
- 25. Radiotherapy in Osteosarcoma Indications: -Complete surgical resection not feasible - Inadequate surgical margins - Osteosarcoma of the head and neck with positive or uncertain resection margins - Axial skeleton - Pelvis - Palliation of metastatic bony sarcomas - Adjuvant whole lung irradiation
- 26. RT Treatment Planningand dose Guidelines to optimal RT - Evaluation of extent - Patient immobilization - Planned using CT simulation - reproducible position - Multiple beam-shaping devices - 3D CRT / IMRT Target volume • Large volume fields • Areas to be resected + approx. 2cm margin • Shrinking field technique • Use of extended SSD • Parallel opp. Portal
- 27. RT doses • POSTOP RT - 50 – 65 Gy in 25 – 33 # over 5 – 7 wks ( radical) - 40 – 55 Gy in 20 – 28 # over 4 – 5 wks (doubful surgical margins) • PRE OP RT - 35 Gy in 10 # or 25 Gy in 5 # • PALLIATIVE RT - locally advanced 30 – 35 Gy in 10 – 15 # in 2 -3 wks - large bleeding lesions 8 – 10 Gy single #
- 28. RT ….contd • ExtracorporealRT – 250 – 300 Gy • IORT – 45 – 80Gy
- 29. Treatment complications • SURGERY -infection - fracture - non union - joint instability - late osteoarthritis - endoprosthetic loosening - dislocation
- 30. Future outlook - Targetedmolecular therapies and newer Novel agents - Minimally invasive approaches - More durable modular oncology prosthesis
- 31. Conclusion Osteosarcoma isa tumor with highly aggressive metastasizing potential Peak incidence between 10 and 19 years of age 80% to 90% of osteosarcomas occur in the long tubular bones 80–90% seemingly localized disease will develop metastases, mostly in the lungs Neo adjuvant and Adjuvant CT along with Limb salvage surgery play a central role .
- 32.