Aim

Synovial sarcoma (SS) is a malignant soft tissue sarcoma with a poor prognosis because of late local recurrence and distant metastases. To our knowledge, no studies have minimum follow-up of 10 years that evaluate long-term outcomes for survivors.

Introduction: Joint sparing is a prerequisite for biologic reconstructions allowing for permanent healing in bone tumors. The physis not crossed by vessels in children can provide a safe margin for tumor resection. In selected patients we have performed joint sparing procedures either by transepiphysial resection or by epiphysial distraction as introduced by Canadell and San Julian.

Patients and methods: 8 children (1 ewing tumor, 8 osteosarcomas [1 multiple localizations]) with open physes 3 distal femurs, 6 proximal tibiae) were treated for metaphysial tumor localizations touching but not crossing to the physis. In 4 localizations epiphysial distraction was used, in the others transepiphysial resection. Reconstructions were performed with vascularized fibula alone in 4 cases, with vascularized fibula transfer and allograft in 1 patient, in the others only intercalary allografts were used.

Results: F/u is 3 to 12 years. No local recurrence occurred. One intercalary allograft failed for infection after irradiation; this was salvaged by a modified rotation plasty. One patient with fibula reconstruction of the femur needed reosteosynthesis due to lack of fusion with a finally excellent result at 3 years f/u, in one the fractured allograft needed be replaced by autologous bone following temporary cement spacer, but the epiphysis could be retained. All patients have excellent joint function. Shortness due to loss of the physis is corrected by contralateral epiphysiodesis and/or lengthening.

Conclusion: Epiphysial sparing tumor resection can be successful oncologically if patients are properly selected and surgery is respecting the tumor margins.

Rationale: Osteosarcoma predominantly affects adolescents and young adults. Reduced fertility in men is well documented following treatment for osteosarcoma and related to chemotoxicity.

We have however not found data about the health of children of patients formerly treated for osteosarcoma.

Among our few patients we have had one offspring with an infantile fibrosarcoma successfully treated with high dose chemotherapy and surgery. One mother has secondary gastric malignancy after successful pregnancy.

With this contribution we want to draw the attention to include data of children in the long-term implications of osteosarcoma and its treatment.

Materials and Methods: Patients: Of 75 patients with osteosarcoma 11 patients (5 women, 6 men) have 16 children‚ produced’ after completed oncologic treatment

All women became pregnant as planned. There are no female patients evidently infertile. One man among our patients shows azoospermia and is infertile. One man with oliogespermia has a healthy daughter after successful vitro fertilisation.

All patients have had treatment for osteosarcoma after puberty.

Offsprings: Pregnancy and delivery were uneventful for all children. The one girl mentioned above at birth showed a tumor of the Plexus brachialis which was a biopsy proven infantile fibrosarcoma. She received high dose chemotherapy. Resection of the tumor retaining the brachial at 9 months of age showed only scarce tumor residuals; she is disease free at 4 years of age. Her two siblings are healthy

Conclusion: We want to stress that in follow up studies events during pregnancy and health of offsprings should be included.