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

GOS Imaging and chemotherapy  How much must we sacrifice?

GOS If the margin is hard, delay  Ewing’s sarcoma in 11 year old

GOS MRI  shows the growth plate is crossed  Anterior extent is not clear

GOS Repeat staging after Chemotherapy Before chemo After chemo

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

GOS 5 years post op

GOS 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, (3): p Margin determines outcome: p< /31 patients with LR cured “Amputate if margins inadequate”

GOS Competing risks  Damage vs risk of relapse  In LBSTTS –Amputation has 27% 5 year survival –LSS has 78% 5 year survival Non randomised…

GOS Planned resection and correction

GOS Operating is easy  After a good response to nactx

GOS 6 months post op

GOS 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