RELAPSED OSTEOSARCOMA - Amazon Web Services
Transcript of RELAPSED OSTEOSARCOMA - Amazon Web Services
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RELAPSED OSTEOSARCOMA
CAN THERE BE A HAPPIER ENDING?
CHETAN DHAMNE
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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
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29 July 2014
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27 Aug 2014
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• VATS 2ND OCTOBER 2014
• NO CHEMOTHERAPY
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6th Jan 2015
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26 June 2015
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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.
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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.
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• SOLITARY NODULE NO ROLE OF CHEMOTHERAPY
• NOW 1 YEAR AFTER COMPLETION OF TREATMENT AND DOING FINE
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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
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9th October 2013
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• PLEURODESIS 16TH OCTOBER 2013
• GEMCITABINE DOCETAXEL 2 CYCLES
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7th November 2013
2nd December 2013
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• DECEMBER - HICUPPS AND BACK PAIN
• LESIONS PROGRESSED ON 2 CYCLES OF GEMCITABINE AND
DOCETAXEL
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7th January 2014
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• JANUARY AND FEBRUARY - 2 CYCLES
• HIGH DOSE IFOSFAMIDE 14G/M2
• BACK PAIN GOT BETTER
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11 March 2014
I have a dream and some unfinished business
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27 June 2014
I want to see the world
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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
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• SEPTEMBER 2013 PRESENTED WITH C/O RIGHT KNEE PAIN
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20 October 2013
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• 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
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10 February 2015
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• NK CELL THERAPY
• TEMPORARY RELIEF OF PAIN
• PROGRESSION OF DISEASE
• WHAT ELSE CAN I DO?
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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
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10th September 2013
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• 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
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17th February 2014
18th March 2014
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• STARTED ON THALIDOMIDE AND CELECOXIB MARCH 2014
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10 September 2014
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10 September 2014
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10th February 2015
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• APRIL 2015 ADDED SORAFENIB AND EVEROLIMUS
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17th June 2015
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Thank you