Publié sur : International Workshop on brain. Bone and soft tissue Tumors. Paris - 2003
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Treatment of advanced pelvic osteosarcoma with chemotherapy directly inside the tumor.
E.Guikov, S.Alkallaf, B.Markowska, H.Cornille, I.M.Bigirimana, G.Delépine, Nicole Delépine

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Treatment of advanced pelvic osteosarcoma with chemotherapy directly inside the tumor.

Case report - Introduction

Very large tumors of pelvis often seem inoperable and are treated by palliative radiotherapy and/or chemotherapy.
We present here a case with intratumoral chemotherapy and mid-term result.

This girl, 16 years old

She came from Africa in 2000 July, for a huge tumor of pelvis after 2 years of pelvic pain.

August 2000. needle biopsy

The biopsy confirmed the diagnosis of high grade osteosarcoma.
No distant metastase was seen on bone and scan.

Conventional chemotherapy didn't obtain any objective response.

As no carcinologic surgery seemed possible the patient was sent in a palliative care unit after 2 months of an ineffective treatment.

October 2000 she came to our unit.

Initial screening showed a huge tumor (15 cm x 12 x 10) developed from the right acetabulum, with compression of bladder and ureters.

October 2000

After intratumoral currettage we started both general and local chemotherapy infused directly inside the tumor cavity through an infusion catheter.

Both intra-tumor and intravenous chemotherapy were continued

We observed an impressive tumoral schrinkage (75% of initial tumoral volume) new debulking surgery was performed and the urinary tract could be repaired.

October 2001

The last tumor residual was removed and a composite acetabular reconstruction performed.

One year after surgery the hip function rated according to Ennecking's criteria is excellent

Oncologic Result

In april 2003, 30 months after she was considered to have a life expectancy less than 1 month ,the patient is in complete remission.
She can walk, go to school and live normally.

Conclusion

Advanced sarcoma can sometimes benefit of an individualized treatment including intratumoral chemotherapy.

"les seuls combats perdus d'avance sont ceux qu'on ne livre pas"

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