PROFILE OF OSTEOSARCOMAS

PATIENTS AT Dr. KARIADI

GENERAL HOSPITAL IN
SEMARANG

JANUARY 2002 DECEMBER 2006

 OSTEOSARCOMA
Primary true bone neoplasm
2nd most common in musculoskeletal neoplasm
after mieloma
At the metaphysis of the long bone
Osteoblastic series of primitive mesenchymal
cells (*)

(*) Solomon L, Warwick D, Nayogam S, Apleys System of Orthopaedic and fractures

 INCIDENT
Children, adolescent & young adult
Peak : 15 19 y.o 8 11 per 1 million(*)
Male : female = 1,4 : 1(**)
Location : most active growth site
femur 42% 75% distal femur(***)

(*) (**) European And American Osteosarcoma Study Group (EURAMOS),

(***) Crippe T P, Osteosarcoma, Emedicine, last update : July 25, 2006
 ETIOLOGY
Hereditary abnormalities : exostosis,
retinoblastoma, Olliers disease, osteogenesis
imperfecta, fibrous displasia & Pagets disease
Radiation exposure
 CLINICAL SYMPTOMS
Symptoms present weeks or months before
Pain : intermitten constant & severe
Fatique & body weight decrease
Impairment of extremities function
Patologic fracture : 1 % (*)
Metastasize : 15 20% (**) most to the lung

(*)(**) European And American Osteosarcoma Study Group (EURAMOS),

 WHO CLASSIFICATION
Central (Medullary)
Conventional high-grade central osteosarcoma
Telangiectatic osteosarcoma
Intraosseus well-differentiated (low-grade) osteosarcoma
Small cell osteosarcoma

Surface (Peripheral)
Parosteal (juxtacortical) well-differentiated (low-grade)
Periosteal (low-to-intermediate grade)
High-grade surface osteosarcoma

(*) European And American Osteosarcoma Study Group (EURAMOS),

 DIAGNOSTIC PROCEDURE
Lab studies : Alkaline Phospatase, LDH
Plain x-ray : 2 projection osteoblastic, osteolitic
CT scan or MRI
Bone scan
Biopsy : open, percutaneus, fine needle
 TREATMENT
Chemotherapy : doxorubicin, cisplatin,
metotrexat, ifosphamide dan etoposide
Radiation therapy
Operation proc : lim-sparring, amputation
 OBJECTIVE
To know profile of osteosarcomas patient at
Dr. Kariadi General Hospital in Semarang
from January 2002 December 2006.
 DESIGN & SETTING
Data from medical record of osteosarcomas
patient which manage at Dr. Kariadi General
Hospital Semarang from Januari 2002
Desember 2006.
Data : sex, age, tumour location & treatment
 RESULT & DISCUSSION
Patient amount : 24 patients
Age : 0 10 yo : 0 patient
11 20 yo : 12 patients ( 50% )
21 30 yo : 4 patients ( 16,7% )
> 30 yo : 8 patients ( 33,3% )
Children, adolescent & young adult the most common
affected group of age
the peak : 15 19 yo : 8 11 per 1 million
associated with the fast growing episode of young bones
(*)
(*) European And American Osteosarcoma Study Group (EURAMOS),
 RESULT & DISCUSSION

Male : 15 patients ( 62,5% )

Female : 9 patients ( 37,5% ) 1,7 : 1

Male affected more than female = 1,4 : 1(*)

16
14
12
10
8
6
4
2
0
male female

(*) European And American Osteosarcoma Study Group (EURAMOS),

Crippe T P, Osteosarcoma, Emedicine, last update : July 25, 2006
 RESULT & DISCUSSION
Location : most frequent : femur : 14 patients (58,3%)
distal femur : 8 patients (33,3%)
At the most active epiphyseal growth.
Femur : 42% with 75% at distal femur.(*)

14
12
10
8
6
4
2
0
femur tibia fibula humerus pedis

(*) Crippe T P, Osteosarcoma, Emedicine, last update : July 25, 2006

 RESULT & DISCUSSION
Treatment :
a. Chemotherapy : 2 patients
b. Radiation : 1 patient
c. Operation : 9 patients :
above knee amputation : 6 patients
below knee amputation : 1 patient
coxae disarticulatio : 1 patient
d. above knee amputation + chemotherapy : 1 patient

Refused further treatment : 9 patients

Passed-away in hospital : 2 patients

 CONCLUSIONS
The 2nd most common neoplasm of musculoskeletal after mieloma
24 patients of osteosarcoma at Dr. Kariadi General Hospital in
Semarang from January 2002 December 2006
Ratio between male : female = 1,7 : 1
Most common age : adolescent & young adult between age 11 20 :
12 patients (50%).
Most common location : femur : 14 patients (58,3%) with distal
femur : 8 patients (33,3%).
Treatment :
Chemotherapy : 2 patiens,
radiation therapy : 1 patients,
 CONCLUSION
Operation proc : 9 patients
above knee amputation : 6 patients,
below knee amputaion 1 patient
coxae disarticulation 1 patient,
above knee ampuation & Chemotherapy : 1 patient.

Refused further treatment : 9 patients

Passed-away in hospital : 2 patients

 It needs cooperation between
Orthopaedic, Radiologic & Anatomy Patologic
department in diagnosis of osteosarcoma
It needs combination of treatment to gain
maximum result
THANK YOU