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

2. GOS Imaging and chemotherapy  How much must we sacrifice?

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

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

5. GOS Repeat staging after Chemotherapy Before chemo After chemo

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

7. GOS 5 years post op

8. 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, 1998. 69(3): p. 230-6. Margin determines outcome: p<0.001 1/31 patients with LR cured “Amputate if margins inadequate”

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

10. GOS Planned resection and correction

11. GOS Operating is easy  After a good response to nactx

12. GOS 6 months post op

13. 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