engleski

Results of treatment of osteosarcoma in 20 children

In the period from1990-1995 there were 20 children with diagnosis osteosarcoma treated at the Children's Hospital Zagreb- Center for solid tumors. There were 10 boys and 10 girls aged 6-18 yrs in the examined group. Diagnosis was defined in children by one of the cytomorphological methods and confirmed by pathohistological analysis. According to TNM calssification before treatment 19 patients (95%) were classified as T2N0M0and in one patient metastatic changes were found (T2N0M1). Eighteen patients were treated preoperatively with HD MTX ( Rosen T-10 protocol or Delepine modification) While in two patients surgical treatment was performed immediately after diagnosis without preoperative chemotherapy. After the preoperative chemotherapy T1N0M0 was found in 14 patients (65%). In 13 patients partial bone resection was done ( # death), and in 7 patients limb amputation (3 death). In 7 patients treatment was started within one month of diagnosis and in 13 patients treatment started later (2-6 months) after the first symptoms. After the preoperative chemotherapy T1N0M= was found in 14 patients (65%). Based on postoperative pathohistological finding (according to the % of necrosis) chemotherapy by protocol T-10 or its modification, was continued in 16 patients, while 4 patients received CDDP+Adr. In 6 patients we found metastases: in 1 patient at the time of diagnosis while 5 of them developed metastases after treatment. Patients with metastases received as second-line chemotherapy: Holoxan, Carboplatina, VP-16 and Cisplatina with radiation. A total of 6 patients died ( 5 patients with metastatic progression of disease, 1 patient-complication of sepsis). The aim of the study was examine succes of treatment of osteosarcoma in correlation with: start of treatment, finding of metastases, increased value of alkal phosphatasis and LDH and scintigraphic finding. The results are shown in the study. In this study the results of complication are also shown. Fourteen patients are intensively followed up. In conclusion: we have worse results in patient with spreading of the tumour in to soft tissue, despite preoperative chemotherapy, in patients with increased value of alkal phosphatasis and LDH and in patients without improvement of scintigraphic finding after preoperative chemotherapy. There is question arising from our experiance for additional therapy in such cases.

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