title: [Changes in the management of osteosarcomas of long bones in the Léon Bérard Center, in the last twenty years ].
abstract: From 1958 to 1977, 68 patients with long bone osteosarcoma were treated with high dose radiation (greater than 80 grays) followed by amputation when needed. The survival rate free of disease is 33% at three years (23/68) and 31% at five years (20/64). Sterilization of the limb was obtained in 72% of cases (18/25 amputation specimens). Preservation of a functional limb often proved impossible because of the frequent occurrence of trophic disorders, especially fractures, after radiotherapy. The main benefit of primary irradiation is to avoid amputations that have become useless because pulmonary metastases have arisen. Surgical excision of pulmonary metastases can lead to prolonged survival (3 out of 6 patients alive free of disease at three years). As no conclusive randomized trials are as yet available, the benefits of adjuvant therapy (chemotherapy and/or radiotherapy) are still prospective. The present policy is to use adjuvant therapy in all cases, conservative treatment for small lesions, primary amputation in children under fourteen, and primary irradiation followed by systematic amputation one year later for extensive lesions in older patients.
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical; D001859:Bone Neoplasms / Q000532:radiotherapy / Q000628:therapy*; D005121:Extremities / Q000473:pathology; D005602:France; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary / Q000628:therapy; D008727:Methotrexate / Q000008:administration & dosage; D012516:Osteosarcoma / Q000532:radiotherapy / Q000556:secondary / Q000628:therapy*
chemical_list: D008727:Methotrexate
vernacular_title: Evolution du traitement des sarcomes ostéogènes des os longs au centre Léon Bérard au cours de vingt dernières années.