Diagnoses, treatment, and oncologic outcomes in patients with calcaneal malignances: Case series, systematic literature review, and pooled cohort analysis

Abstract

Background and Objectives: Malignant tumors of the calcaneus are rare but pose a treatment challenge. Aims: (1) describe the demographics of calcaneal malignancies in a large cohort; (2) describe survival after amputation versus limb-salvage surgery for high-grade tumors. Methods: Study group: a "pooled" cohort of patients with primary calcaneal malignancies treated at two cancer centers (1984−2015) and systematic literature review. Kaplan−Meier analyses described survival across treatment and diagnostic groups; proportional hazards modeling assessed mortality after amputation versus limb salvage. Results: A total of 131 patients (11 treated at our centers and 120 patients from 53 published studies) with a median 36-month follow-up were included. Diagnoses included Ewing sarcoma (41%), osteosarcoma (30%), and chondrosarcoma (17%); 5-year survival rates were 43%, 73% (70%, high grade only), and 84% (60%, high grade only), respectively. Treatment involved amputation in 52%, limb salvage in 27%, and no surgery in 21%. There was no difference in mortality following limb salvage surgery (vs. amputation) for high-grade tumors (HR 0.38; 95% CI 0.14−1.05), after adjusting for Ewing sarcoma diagnosis (HR 5.15; 95% CI 1.55−17.14), metastatic disease at diagnosis (HR 3.88; 95% CI 1.29−11.64), and age (per-year HR 1.04; 95% CI 1.02−1.07). Conclusions: Limb salvage is oncologically-feasible for calcaneal malignancies.

Total calcaneal allograft reconstruction of an Ewing's sarcoma in a child: Outcome and review of the literature

“…It has been studied that in these cases, although the cortex is involved, the anatomical characteristics of the calcaneus make limb salvage possible. 5 , 20 In the calcaneus only one aspect of the bone is close to the major neurovascular structure. Depending on the size and location of the extraosseous part, free surgical margins can be achieved by total calcanectomy along with the extraosseous part without sacrifice of the major neurovascular structure, which is important to maintain foot function.…”

“… 4 , 5 Because the standard treatment is amputation, only a few reports that include the surgical limb salvage options have been published. 5 , 6 …”

“…In sarcomas of the foot, including the calcaneus, below-knee amputation has been the standard choice of local control due to its poor compartmentalization. 4,5 Because the standard treatment is amputation, only a few reports that include the surgical limb salvage options have been published. 5,6 With the development of effective chemotherapy and advanced imaging techniques, limb salvage surgery could be considered the treatment of choice for primary calcaneus malignancy.…”

“…4,5 Because the standard treatment is amputation, only a few reports that include the surgical limb salvage options have been published. 5,6 With the development of effective chemotherapy and advanced imaging techniques, limb salvage surgery could be considered the treatment of choice for primary calcaneus malignancy. 5,6 Different types of calcaneal reconstruction following tumor resection have been reported in few case reports.…”

“…5,6 With the development of effective chemotherapy and advanced imaging techniques, limb salvage surgery could be considered the treatment of choice for primary calcaneus malignancy. 5,6 Different types of calcaneal reconstruction following tumor resection have been reported in few case reports. These techniques included bone allografts, vascularized or pedicle bone autografts, composite allografts with vascularized fibula, and custom-made calcaneus prosthesis.…”