title: Osteosarcoma presentation stages at a tumour unit in South Africa.
abstract: BACKGROUND
  Osteosarcoma is the most common malignant bone tumour found in children and adolescents. Changed treatment protocols have resulted in improved survival and the opportunity for limb salvage surgery. Despite these advances, the outcome is mainly determined by the stage of disease at presentation, making early referral to a tumour unit essential.
  
  
  METHODS
  Between July 2009 and October 2011, 25 consecutive patients were diagnosed with biopsy-confirmed osteosarcoma. Their records were reviewed and information extracted regarding clinical presentation, histological subtype and stage of disease.
  
  
  RESULTS
  Twenty-four patients met the inclusion and exclusion criteria. Conventional osteosarcoma was the most common histological diagnosis encountered; 16 out of 24 (66.7%) patients had metastases at presentation; 6 of the remaining had advanced local disease with very large tumours or pathological fractures that precluded limb salvage surgery.
  
  
  CONCLUSIONS
  The great majority of patients referred to our tumour unit present with locally advanced or metastatic disease, which limits treatment options and adversely affects survival. Increased awareness, a high index of suspicion and appropriate early referral is crucial to enable limb salvage surgery and increase disease-free survival rates.
authors: Tumour, Sepsis and Reconstruction Unit, Department of Orthopaedic Surgery, Greys Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa. drferreiran@gmail.com
authors: Nando
authors: N
authors: Ferreira
authors: Leonard Charles
authors: LC
authors: Marais
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D002648:Child; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000453:epidemiology* / Q000473:pathology*; D013019:South Africa / Q000453:epidemiology