Standards, Options and Recommendations (SOR) for diagnosis, treatment and follow-up of osteosarcoma

The "Standards, Options and Recommendations" (SOR) project; started in 1993 , is a collaboration between the Federation of the French Cancer Centres (F NCLCC), the 20 French Cancer Centres and specialists;om French Public Unive rsities, General Hospitals and Private Clinics. For pediatic issues, this p roject is a collaboration between the FNCLCC and the French Society of Pedi atric Oncology (SFOP). The main objective is the development of clinical pr actice guidelines to improve the quality of health care and outcome for. ca ncer patients. The methodology, is based on literature review, and critical appraisal by a multidisciplinary group of experts with framework from spec ialists in cancer care delivery. Objectives: To develop clinical practice g uidelines according to the definitions of Standards, Options and Recommenda tions for the clinical care of osteosarcoma in children and adult. Methods: Data have been identified by literature search using Medline (1985-decembe r 1998) and the expert groups personal reference lists The main criteria co nsidered were incidence, risk factors, prognostic factors and efficacy pf t reatment. Once the guidelines were defined, the document was submitted for review, to 27 national and international independent reviewers, and to the medical committees of-the 20 French Cancer Centres and in particular, the 4 which have particular expertise in pediatric cancer management. Results: T he main recommendations for osteosarcoma management are that 1) the clinica l diagnosis is based on appropriate clinical and radiological findings; 2) the final diagnosis is pathological and the biopsy should be performed by t he surgeon who will subsequently perform the definitive surgery; 3) surgica l biopsy must be of adequate size and performed by an experienced surgeon; 4) the therapeutic strategy for osteosarcoma is based an surgery with neoad juvant and adjuvant chemotherapy given in experienced centres. Inclusion of high dose methotrexate is recommended for children, and the dose of methot rexate must be adapted for adults. Inclusion of children in SFOP protocols and adults in EORTC and FNCLCC clinical trials is recommended ; 5) treatmen t of metastratic osteosarcoma is based on chemotherapy and surgery to lung metastases which may be curvative Amputation is rarely appropriate. Inclusi on of children in SFOP and of adult in EORTC and FNCLCC clinical trials for metastatic osteosarcoma is recommended; 6) at the present time, there are no clear data on which to base guidelines for timing and duration of follow -up studies in this condition.