Limb Salvage in Bone Sarcomas in Patients Younger Than Age 10

Abstract

The authors present their experience over the last 20 years in limb salvage procedures of a consecutive series of 40 children under 10 years of age (range 2-10 years) with bone sarcomas. Nineteen were osteogenic sarcomas and 21 were Ewing sarcomas. Only one case, located in the distal phalanx of the toe, was treated by straightforward amputation. Intercalary allografts and Canadell's technique were used to preserve joints whenever possible, and prosthesis or osteoarticular allografts were used when the joint surface was involved. Survival rate in this series was 75%. There were four local recurrences. At the last follow-up (mean 11.2 years, range 5-19 years postop), 90% of the patients preserved their limbs. Eighty percent of the authors' results were excellent or good according to the Musculoskeletal Tumor Society Scale. Limb salvage is a real possibility even in young children with bone sarcomas. The age of the patient itself is not a contraindication for limb salvage.

Allograft reconstruction for bone sarcoma of the tibia in the growing child

“…2,3 If adequate resection margins are achieved after local excision of the tumour, limb reconstruction can be performed by endoprosthetic replacement, 4 expandable endoprosthetic replacement [5][6][7] or biological reconstructions such as shortening and rotationplasty, 7,8 free microvascular bone transfer 9 with or without allografts [10][11][12] or allografts alone. [13][14][15][16][17][18][19][20][21] Additionally, a technique for jointsparing resection using physeal distraction has been introduced by Canadell, Forriol and Cara, 22 and San-Julian et al 23,24 With endoprosthetic reconstruction the knee joint is resected. Fixation of the prosthesis affects the growth plate of the distal femur even if the stem crossing the physis is smooth.…”

Epiphyseal distraction prior to resection in paediatric bone sarcomas

“…Whether this is due to early diagnosis or because the median age was lower in this subgroup, it remains a fact that these patients have a better prognosis. 28,29 Additionally, it must be accepted that those tumours not crossing the physis are less aggressive than those that do. More metastases are present at the diagnosis in the group without preservation of the epiphysis (38% vs 22%).…”

Preliminary clinical research on epiphyseal distraction in osteosarcoma in children

“…According to the image staging method of San-Julian [5], the invasion of sarcoma in the metaphysis of children is divided into three types: type I, the distance between the lesion and the epiphyseal plate is more than 2 cm; type II, the distance between the lesion and the epiphyseal plate is less than 2 cm or they are adjacent to each other; and type III, the lesion has partly invaded into the epiphysis. Although the growth plate of the cartilage can prevent the tumor from diffusing, the barriers of it are by no means impassable.…”

“…All tumors were staged according to the Enneking method: IIA for six cases, IIB for four cases. The extent of tumor invasion was also classified according to the image staging method of San-Julian [5] and determined to be type I for five cases and type II for five cases. All patients received neoadjuvant chemotherapy according to the COSS 86 scheme [6].…”

“…The patients had to meet the following criteria: 1) the physis of the involved distal femur was open; 2) tumors were sensitive to preoperative chemotherapy; 3) the location of the lesion was classified as typeI or typeII of image staging using the San-Julian method [5] (Figure  1a,b); 4) after two weeks of preoperative neoadjuvant chemotherapy, laboratory results, such as routine blood, hepatic and renal function, serum electrolytes, blood coagulation function and accessory examinations, such as electrocardiograms, of the patients were normal; and 5) there was no local (at the biopsy position) or general infection in the patients.…”