osteosarcoma | Support for adult Osteosarcomas

Support for adult Osteosarcomas

Summary
The National Cancer Institute promotes the establishment of redress meetings and national structured networks for the management of rare cancers. Adult Osteosarcomas are an example of a disease that is part of this dynamic. The aim is to improve the quality of care, facilitate access to highly specialized expertise and stimulate clinical research. Professors Gouin (Orthopedics, Nantes) and Anract (orthopedics, Paris) are coordinating this project. This article is a magazine centered on the management of the osteosarcoma of the adult and its specificities.

Keywords
Rare Cancer osteosarcoma multidisciplinarity Network remedies Article written as part of an AP-HP call for project and presented at ICACT 2008.

Management of Adult Osteosarcomas
Abstract
The French National Cancer Institute informs the Organization and implementation of meetings and National structured networks dedicated to the management of rare cancers such as adult osteosarcoma. The goal is to improve the quality of care, to help obtaining specialized expertise and advice, and to promote clinical research. Professors Gouin (Orthopaedics, Nantes) and Anract (Orthopaedics, Paris) are driving this national project. This paper presents a literature review focused on the management of adult osteosarcoma and its specificities.

Keywords
Rare Cancer Osteosarcoma Multidisciplinarity Sarcoma Network

Management of Adult Oste ´ Osarcomes *
Management of Adult
Osteosarcomas
Abstract: The French National Cancer
Institute of the Organization
and implementation of
Meetings and national structured
Networks dedicated to the management
Of rare cancers such as adult
Osteosarcoma. The goal is to
Improve the quality of care, to help
Obtaining specialized expertise
and advice, and to promote clinical
Research. Professors Gouin (Orthopaedics,
Nantes) and Anract (Orthopaedics,
Paris) are driving this
National project. This Paper Presents
A literature review focused
On the management of adult osteosarcoma
and its specificities.
Keywords: Rare cancer – Osteosarcoma
– Multidisciplinarity –
Sarcoma Network
Re ´ sume ´: the National Cancer Institute
Encourages the setting up of
Re ´ Unions of Appeal
and re ´ national buckets structure ´ s
For the management of cancers
Rare. The Oste ´ osarcomes of the adult
Are an example of disease
That goes into this dynamic.
The aim is to allow a ´ soul to
Improvement of the ´ quality of care, a
Facilitation of access to expertise
spe ´ cialis ´ and a dynamic
of clinical research. The
Professors Gouin (Orthope ´ die,
Nantes) and Anract (Orthope ´ die,
Paris) are coordinating this project.
This article is a review centre ´ E on
Support for the Oste ´ osarcome
Adult and its SPE ´ unique features ´ s.
Key words ´ s: Rare Cancer – Oste ´ osarcome
– Pluridisciplinarite ´ –
Remedies – Re ´ bucket
Introduction
The adult Oste ´ osarcomes are
Rare, severe cancers and taking
In a complex load. They do ´ require
Coordination between expertise
´ and Surgical,
They are very specific ´. The
Prognosis is less good and taking
In charge less standardized ´ e than
Adolescent and child. The Taking
Overall responsibility of these patients
Should be ´ improves ´ by facilitating the
From the access to multidisciplinary opinions
´ cialis ´ and the implementation
Progressive place of a re ´ bucket
Territorial e ´ equipes re ´ fe ´ annuites. The
CRE ´ of a re ´ bucket of taking
Charge of Oste ´ osarcomes of
The aim of the adult is to make
Possible to access a pluridisciplinarite ´
spe ´ cialis ´ e, for any
Patient. The National Dynamics
"Rare cancers" has just ´ develop,
Strengthen and give a consistent ´
A sum of individual initiatives
No ´ necessarily coordinates ´
're. It sets as a priority ´
To "ensure the ´ quite ´ for access to the
Diagnosis, treatment and taking
In charge of people suffering from
of a rare cancer.
Rare cancers require a
Pluridisciplinarite ´ whose degree ´
of spe ´ cialis ´ need to be
Proportional to the ´ degree of rare ´
of cancer. The inte ´ gration of Oste ´ osarcomes
of the adult within
The ´ entity of rare diseases takes
It all makes sense. Thus, the E ´ careful study
Of the anamne of Oste ´ osarcomes
Shows that wanderings and delays
To the diagnosis are fre ´ frequent and
Sometimes accompanied by ´ steps
Outliers and ´ the ´ te ' Res. As well
Mankin et al. ´ shows ´ the importance of
Expe ´ Experience of the E ´ team
Danslajustesse Dela Support
[16]. In this ´ study
597 patients, from 21 centres
Me ´ Dicochirurgicaux, for whom
A suspected tumor
Malignant musculoskeletal justified
A biopsy, the error rate
Biopsy diagnosis is to
12.3% in the Centre spe ´ cialise ´ and
27.4% in the centre non spe ´ cialise ´.
In 8.5% of cases, the prognosis and
E ´ volutivite ´ later ´ have e ´ te ´ gravely
Alte ´ re ´ s by the initial gesture. This
Diagnostic error rate, including
At the same time serious errors
(Malin – Be ´ Nin) and ´
Less conse ´ prevalent (´ histological),
E ´ was three times more e ´ leve ´
In treatment centres not
spe ´ cialis ´ s.The entire national project
"Sarcomas" is ´ door by two
´ distes orthope Surgeons, PRS
Gouin (Nantes) and Anract (Paris).
Their national structuring efforts
should contribute to ´ improve
Access to care and the ´ quality of
Taking care of the sick,
Promoting research and innovation
The ´, Faciliterlede ´ Development
of national partnerships
and Europe ´ Ens. On the occasion of this
News ´, we do a review
Support conditions

Current Oste ´ Osarcomes of
The adult and the difficulties ´ meets ´ es.
of ´ Walking Diagnostic
The diagnosis of Oste ´ Osarcome
Based on the confrontation of Donne ´
Es e ´ pide ´ epidemiological, radiological
and Anatomocliniques.
E ´ pide ´ epidemiology de oste ´ osarcome
of the adult [10.14]
In adults, the main causes of
of malignant bone tumor are
First the ´ me tastases bone
of solid tumors [12], then more
Rarely, the clam ´ lomes (3 600
New cases per year), and still
More rarely, bone tumors
Primitive.
The most
Fre ´ Frequent group the Oste ´ Osarcome,
Ewing's sarcoma and
Chondrosarcoma. There are different ´
E ´ pide ´ epidemiological re ´ sume ´
are in table 1. Sarcoma
of Ewing is exceptional at
The adult over 50 years. Conversely, the
Chondrosarcomas are
Primitive tumors, especially observed ´
In the adult.
The oncogene ' Sedesoste ´ osarcomes
is promotes ´ by loss of function
of Ge'nes tumor suppressors,
such as Rb and p53, but the fre ´ sequence
Of these anomalies in the forms of
The adult is not documented ´ E. The
Oste ´ osarcomes have an impact profile
Biphasic, with a first
Pic In adolescence and a second
Peak in adults age ´. Aging
Of the population suggests
What could be a third
Peak, beyond ' 75 years. The second pic
is directly linked ´ to ´ ge ´ ne ´ rescences
Sarcomateuses on pathological bone.
The main diseases
Be ´ Nignes in issue are the disease
Of Paget, the Oste ´ ochondrome Solitaire,
The exostosis oste ´ emb ´
Ollier's disease, and ante ´ this ´ teeth
Radiation, particularly for re ´ tinoblastome,
Ewing's sarcoma, and
Soft tissue sarcoma [10.14].
The Oste ´ osarcome of the young subject
Can touch all the bones but manifest
A pre ´ dilection for the Me ´ Taphyse
Long bones. The Oste ´ osarcome
Of the adult includes the locations
Municipalities observe ´ in the adolescent,
such as the extremely ´ mite ´ NCI ´-
Of the ´ fe Wall (40%), the extremely ´ mite ´
Supe ´ of tibia (15%), extremely ´ mite ´
Supe ´ of the FE ´ Wall and the Hume ´ Rus
(14%), but also ´ locations
Rarer in adolescents:

Rachis, pelvis, spit and face...
Pre ´ Clinical Presentation
and circumstances of ´ covered
of a oste ´ osarcome of the adult
The sympto of ´ covered with a
Oste ´ osarcome The most fre ´ is
A pain locates ´ E (90% of cases).
His nocturnal characterized, permanent
At rest, is suspicious. A tume ´ faction
Local appear in a second
Time and is re ´ ve ´ Latrice without pain
Associates ´ E in 10% of cases. It's a
Excess joint swelling, sometimes
Inflammatory, painful to palpation.
The occurrence of signs
Local calling on a particular ground,
Particularly during the
followed by a patient with an ante ´ this ´-
Cancer tooth irradiates ´ or followed for
Bone disease be ´ mild, will lead
More quickly ´ revoke the diagnosis.
A local trauma re ´ Hundred
is often found ´. It is not the
Cause of sarcoma, but promotes
´ the ´ of the tumor process
And his re ´ ve ´ clinical.
of ´ Walking Diagnostic
In the face of suspicion
Oste ´ Osarcome [3, 7, 8,25]
Examination-based diagnosis
Clinic, simple X-ray
Bone and biopsy
Inspection and Palpation can
Do e ´ revoke the diagnosis, but
It is the simple X-ray, which
Quickly brings information
of ´ Resolute. Comparative with
The other ´, face and profile, it
Affirms the existence of a ´ sion
Bone. It can be lytic,
Condensed or mixed; The ´ degree
Oste ´ ocondensation is variable and
Te ´ testifies of the degree ´ of Diffe ´ differentiation
Sarcoma. The X-ray
Re ´ ve ' The one anomaly of the frame
Bone, a rupture of the cortical,
PE ´ riose ´ es, with
swamping of soft parts.
The Appearance ´ epidemiological radiological
is important to confirm the indication
of the biopsy and facilitate the ´ interpretation
Anatomopathologic.
In the face of such a radiological aspect,
Biopsy is required for the examination
Anatomopathologic.
The biopsy is an emergency. She
Must not only provide a diagnostic
Pre ´ CIS, but e ´ also do not
The conservative surgery
Future. Indeed, Enouvrantla tumor,
Biopsy lead a seeding
Cellular of all parties
Soft exhibits ´. This imposes later ´-
The RE ´ section of the track
First and biopsy scar
In a monoblock with the tumor. For
This is why it is essential to include
The biopsy route in the line
Future incision and never
Open the anatomical boxes containing
The ´ the noble ´ of the member.
It is re ´ alise ´ E by Trocar
This is where the tumor
is superficial and easily accessible.
She must impe ´ compare
be re ´ alise ´ by the future surgeon.
One of ´ technical need can compromise
Not only the quality ´
Of the surgical gesture later ´, but
Sometimes the patient's survival.
For appreciate ´ the local extension
Of the disease, in addition to the clinical
and standard X-rays,
An MRI of the total ´ of the bone reached
and adjacent structures is
´ necessary. It must be re ´ alise ´
Possible before the biopsy, because it