Osteosarcoma of the Jaws - UCLouvain · Osteosarcoma of the jaws: A 30-year retrospective review....

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Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme

Osteosarcoma of the Jaws

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•• WorkWork--up procedureup procedure

•• TNM stagingTNM staging

•• Primary treatmentPrimary treatment

•• FollowFollow--upup

•• Treatment of recurrent and/or Treatment of recurrent and/or metastaticmetastatic diseasedisease

•• Appendix: surgical techniquesAppendix: surgical techniques

•• ReferencesReferences


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StdStd..StdStd..StdStd..StdStd..StdStd..StdStd..StdStd..

Type CType CType CType CType CType CType CType CType CType CType CType CType CType C

•• CompleteComplete historyhistory ofof thethe diseasedisease•• WeightWeight andand weightweight lossloss•• Performance Performance statusstatus ((KarnofskyKarnofsky or WHO or WHO scalescale))•• GeneralGeneral, Head , Head andand Neck Neck examinationexamination•• EvaluationEvaluation ofof cranialcranial nerves V2, V3, VII, XIInerves V2, V3, VII, XII•• DrawingDrawing ofof allall lesionslesions on a on a commoncommon templatetemplate•• BiopsyBiopsy underunder local or local or general anesthesia aftergeneral anesthesia after imagingimaging

Option Option EvidenceEvidenceStandard Standard clinicalclinical evaluationevaluation

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Advanced clinical evaluation Evidence Option

l Dental examination by oral surgeon l Prosthetic rehabilitation (if maxillectomy) l Nutritional assessment

Type C Type C Type C

Std. Std. Std.

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StdStd..Type CType C•• HemogramHemogram, , ionogramionogram, coagulation tests, , coagulation tests, liverliverenzymes, enzymes, kidneykidney functionfunction

Option Option EvidenceEvidenceLaboratoryLaboratory teststests

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StdStd..StdStd..

StdStd..StdStd..

Type CType CType CType C


•• OrthopantomogramOrthopantomogram (+ dental (+ dental XX--RaysRays if if neededneeded))•• MRI MRI (jaw and neck)(jaw and neck) + CT Scan (bone + CT Scan (bone window window without contrast enhancement)without contrast enhancement)•• Thoracic spiral CTThoracic spiral CT•• Bone Bone scintigraphyscintigraphy

Option Option EvidenceEvidenceLocal Local ImagingImaging andand metastaticmetastatic workwork--upup

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StdStd..Type CType C•• TNM classification (AJCC 2002)TNM classification (AJCC 2002)

Option Option EvidenceEvidenceStagingStaging

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•• TX: Primary tumor cannot be assessedTX: Primary tumor cannot be assessed•• T0: No evidence of primary tumorT0: No evidence of primary tumor•• T1: Tumor 8 cm or less in greatest dimensionT1: Tumor 8 cm or less in greatest dimension•• T2: Tumor > 8 cm in greatest dimensionT2: Tumor > 8 cm in greatest dimension•• T3: Discontinuous tumors in the primary bone siteT3: Discontinuous tumors in the primary bone site

TNM/AJCC 2002 StagingTNM/AJCC 2002 Staging

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•• NX:Regional lymph nodes cannot be assessedNX:Regional lymph nodes cannot be assessed•• N0: No regional lymph node metastasisN0: No regional lymph node metastasis•• N1: Regional lymph node metastasisN1: Regional lymph node metastasis

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•• MX: Distant MX: Distant metastasismetastasis cannotcannot bebe assessedassessed•• M0: No distant M0: No distant metastasismetastasis•• M1: Distant M1: Distant metastasismetastasis

•• M1a : M1a : LungLung•• M1b : M1b : OtherOther distant distant metastasismetastasis, , includingincluding

lymphlymph nodesnodes


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StdStd..StdStd..IndInd..

StdStd..

Type 3Type 3Type 3Type 3Type 3Type 3

Type 3Type 3

•• AnyAny T, N0, M0T, N0, M0lowlow grade (G1): grade (G1): surgerysurgeryhighhigh grade (G2grade (G2--G3): induction G3): induction chemotherapychemotherapy + + surgerysurgery

± post± post--op op RxThRxTh•• AnyAny T, N1T, N1--M1M1

chemotherapychemotherapy11 + surgery+ surgery22 (T, N, M) if possible(T, N, M) if possible

11See recommendations for chemotherapy on slide 22See recommendations for chemotherapy on slide 2222See surgical techniques on slides 18 and 19See surgical techniques on slides 18 and 19

Option Option EvidenceEvidenceTreatmentTreatment

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StdStd..

StdStd..

StdStd..StdStd..StdStd..

Type CType C

Type CType C

Type CType CType CType CType CType C

•• ClinicalClinical examinationexamination ofof headhead andand neck neck mucosamucosa andandneck palpation/ performance neck palpation/ performance statusstatus//nutritionnalnutritionnalassessmentassessment: : everyevery 2 2 monthsmonths ((firstfirst 2 2 yearsyears), ), everyevery 66monthsmonths ((yearsyears 33--5), once a 5), once a yearyear ( > 5 ( > 5 yearyear))

•• Dental Dental examinationexamination andand orthopantomogramorthopantomogram everyevery 66monthsmonths

•• ChestChest spiral CT spiral CT everyevery yearyear•• MRI MRI headhead andand neck neck everyevery yearyear duringduring thethe firstfirst 5 5 yearsyears•• EvolutionEvolution ofof latelate toxicitytoxicity (CTC (CTC scalescale) )

Option Option EvidenceEvidenceFollowFollow--upup

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StdStd..IndInd..


•• ChemotherapyChemotherapy11

•• SurgerySurgery22 ofof thethe metastasismetastasis if possibleif possible11See recommendations for chemotherapy on slide 22See recommendations for chemotherapy on slide 2222See surgical techniques on slides 18 and 19See surgical techniques on slides 18 and 19

Option Option EvidenceEvidenceSalvage Salvage treatmenttreatment for for metastaticmetastatic diseasedisease

StdStd..IndInd..


•• Palliative carePalliative care•• ChemotherapyChemotherapy11/ surgery/ surgery22/ / RxThRxTh

11See recommendations for chemotherapy on slide 22See recommendations for chemotherapy on slide 2222See surgical techniques on slides 18 and 19See surgical techniques on slides 18 and 19

OptionOptionEvidenceEvidenceSalvage Salvage treatmenttreatment for for locoloco--regionalregional diseasedisease

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•• AppendixAppendix: : -- Surgical techniquesSurgical techniques

-- Recommendations for pathological examinationsRecommendations for pathological examinations

-- Recommendations for chemotherapyRecommendations for chemotherapy



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-- Radical Radical surgerysurgery-- mandibulectomymandibulectomy ((extendedextended) ) -- maxillectomymaxillectomy ((extendedextended) ) -- ……

Surgical techniques (2 slides)

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-- ReconstructionReconstructionPrimaryPrimary if if -- goodgood prognosisprognosis

-- RadicalityRadicality

withwith FFreeree flapsflaps ((fibulafibula, , iliaciliac crestcrest))

-- If If nono primaryprimary reconstruction : reconstruction : •• Reconstruction plate (AO or THORP)Reconstruction plate (AO or THORP)

•• MaxillaryMaxillary obturatorobturator prosthesisprosthesis

Surgical techniques

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Recommendations for pathological examinations (2 slides)

•• MacroscopyMacroscopy: : -- 22--10 cm10 cm

•• PathologyPathology: : -- atypicalatypical cuboidalcuboidal or or polyhedricpolyhedric cellscells-- osseousosseous materialmaterial whichwhich cancan bebe osteoidosteoid or or bonebone

•• Classification: Classification: -- tumoral tumoral differentiationdifferentiation: : osteoblasticosteoblastic, , chondroblasticchondroblastic, ,

fibroblasticfibroblastic-- cytologicalcytological atypiaatypia ((BrodersBroders): grade I to IV): grade I to IV

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•• AnalysisAnalysis of of surgicalsurgical specimenspecimen-- preciseprecise tumourtumour extension extension andand resectionresection marginsmargins-- confirmconfirm or or modifymodify the the degreedegree of of atypiaatypia andand thethe

differentiationdifferentiation-- identifyidentify a a preexistingpreexisting lesionlesion-- appreciateappreciate effectseffects of of chemotherapychemotherapy: % of : % of necrosisnecrosis

Recommendations for pathological examinations

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Recommendations for Chemotherapy (1 slide)

•• Localized Localized osteosarcomaosteosarcoma-- CisplatinCisplatin 100 mg/m2 J1 and 100 mg/m2 J1 and adriamycinadriamycin 25 mg/m2, 25 mg/m2, J1J1--J2J2--J3, 6 cycles every 3 weeksJ3, 6 cycles every 3 weeks

•• MetastaticMetastatic osteosarcomaosteosarcoma-- More intensive chemotherapy with More intensive chemotherapy with cisplatincisplatin, high dose , high dose MTX, high dose MTX, high dose IfosfamideIfosfamide and and adriamycinadriamycin+ surgery of the primary site and the metastasis if + surgery of the primary site and the metastasis if feasiblefeasible

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• AJCC Cancer Staging Manual. Springer, New York. Sixth Edition, 2002• Bennett JH, Evans AW, Speight PM. Osteosarcoma of the jaws: A 30-year retrospective review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90 : 323-333.• Daw NC, Mahmoud HH, Meyer WH, Jenkins JJ, Kaste SC, Poquette CA, Kun LE, Pratt CB, Rao BN. Bone sarcomas of the Head and Neck in children. The St. JudeChildren’s Research Hospital experience. Cancer 2000; 88 : 2172-2180.• Gadwal SR, Gannon FH, Fanburg-Smith JC, Becoskie EM, Thompson LDR. Primary osteosarcoma of the Head and Neck in pediatric patients. A clinicopathologic study of 22 cases with a review of the literature. Cancer 2001; 91 : 598-605.

• Kassir RR, Rassekh CH, Kinsella JB, Segas J, Carrau RL. Osteosarcoma of the Head and Neck: Meta-analysis of nonrandomized studies. Laryngoscope 1997; 107 : 56-61.

• Oda W, Bavisotto LM, Schmidt RA, McNutt M, Bruckner JD, Conrad III EU, Weymuller EA. Head and Neck osteosarcoma at the University of Washington. Head Neck 1997; 19 : 513-523.

• Smeele LE, Kostense PJ, van der Waal I, Snow GB. Effect of chemotherapy on survival of craniofacial osteosarcoma: A systematic review of 201 patients. J Clin Oncol 1997; 15 : 363-367.

• van Es RJJ, Keus RB, van der Waal I, Koole R, Vermey A. Osteosarcoma of the jaw bones. Long term follow-up of 48 cases. Int J Oral Maxillofac Surg 1997; 26 : 191-197.

Osteosarcoma of the Jaws - UCLouvain · Osteosarcoma of the jaws: A 30-year retrospective review....

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