Die Chemotherapie des Osteosarkoms

Abstract

Intensified adjuvant chemotherapy increased the 4-year metastasis-free survival probability from 50% (COSS-77) to roughly 80% (COSS-86). Preoperative chemotherapy was found without recognizable hazard and promoting conservative surgery. Following resection the local failure rate ist significantly higher than after demolitive procedures, including rotation plasty (10.5% vs. 2.5%). Local failures bare a very poor prognosis (19/23 DOD). The acute therapy related mortality is less than 3%. Late toxicities like ototoxicity and cardiotoxicity are intriguing and deserve increased attention. The management of the osteosarcoma patient is a complex and difficult interdisciplinary task which is best performed in centers experienced in the treatment of malignant musculo-skeletal tumors.

Hemipelvectomy- only a salvage therapy?

“…59,60 The appropriate grafts can be calculated by CT scans while allografts provide an excellent tool to reconstruct almost a normal pelvic anatomy. 46,58 Here the graft can be modified surgically to fulfill into the complex geometry of the corresponding osseous defect.…”

“…54 However, the disadvantages of this technique are the high risk of bone infections non-unions and allograft fractures. 60 In a comprehensive study with 945 patients the factors influencing the incorporation of the allograft were investigated. The non-union rate in their patient population amounts to 17.3%.…”