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Paediatric Sarcoma Surgery

Paediatric Sarcoma Surgery. Combined UCL Sarcoma Service GOS Oncology and London Bone and Soft Tissue Tumour Service UCLH. Imaging and chemotherapy. How much must we sacrifice?. If the margin is hard, delay. Ewing’s sarcoma in 11 year old. MRI. shows the growth plate is crossed

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Paediatric Sarcoma Surgery

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  1. Paediatric Sarcoma Surgery Combined UCL Sarcoma Service GOS Oncology and London Bone and Soft Tissue Tumour Service UCLH

  2. Imaging and chemotherapy • How much must we sacrifice?

  3. If the margin is hard, delay • Ewing’s sarcoma in 11 year old

  4. MRI • shows the growth plate is crossed • Anterior extent is not clear

  5. Repeat staging after Chemotherapy Before chemo After chemo

  6. Joint sparing expanding massive Epiphysis grows radially and in height After operation At 9 months

  7. 5 years post op

  8. Local relapse and prognosis • Independent predictor of outcome? • Bacci, G., et al., Predictive factors for local recurrence in osteosarcoma: 540 patients with extremity tumors followed for minimum 2.5 years after neoadjuvant chemotherapy. Acta Orthop Scand, 1998. 69(3): p. 230-6. • Margin determines outcome: p<0.001 • 1/31 patients with LR cured • “Amputate if margins inadequate”

  9. Competing risks • Damage vs risk of relapse • In LBSTTS • Amputation has 27% 5 year survival • LSS has 78% 5 year survival • Non randomised…

  10. Planned resection and correction

  11. Operating is easy • After a good response to nactx

  12. 6 months post op

  13. Conservative Surgery today • Meticulous attention to clinical findings • Plan resections with serial imaging • Repeat if necessary • Save any bone segment • The value of a childs joint is incalculable • Surgeon know your place… • We don’t save lives, but we can spoil them

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