Surgical options and outcomes in bone sarcoma

Abstract

Bone sarcomas are challenging to treat. The primary goal of treatment is local control of the disease while, if possible, achieving salvage of the limb and its function. There is no ideal method of reconstruction in limb-salvage surgery but the choice of the method of reconstruction should be individualized based upon many factors including the patient's age, the extent and location of the tumor, the wishes of the patient, and the availability of surgical facilities and expertise, as well as the cost of the procedure. In this review, the authors explore the advantages and disadvantages of the different methods of limb reconstruction. The surgical management of bone sarcomas is a real challenge to the orthopedic surgeon, owing to the diversity of sites in which tumors arise, combined with the extension of the tumor into adjacent soft tissues and their proximity, in many cases, to major neurovascular structures. There have been dramatic improvements in survival for patients with osteosarcoma and Ewing's sarcoma in the past 30 years owing to increasing effectiveness of chemotherapy. This, along with developments in imaging techniques (magnetic resonance imaging in particular) has led to earlier diagnosis and more accurate preoperative staging. Whilst traditional treatment for bone tumors used to be amputation, advances in surgical techniques have made limb-salvage procedures a valid alternative method of treatment to amputation in 80-85% of patients with primary bone sarcomas.

Expression of 11β-hydroxysteroid dehydrogenase enzymes in human osteosarcoma: potential role in pathogenesis and as targets for treatments

“…Osteosarcoma (OS) is the most common primary malignant tumour of bone occurring in children and adolescents (Wafa & Grimer 2006). Surgical resection alone is associated with a survival rate of w11% due to the presence of systemic micrometastases at presentation.…”

“…For patients without clinically evident metastasis, the most important prognostic factor is the response of the primary tumour to chemotherapy. The finding of O90% postchemotherapy necrosis in the primary tumour is associated with a good prognosis (Marina et al 2004, Wafa & Grimer 2006. Conversely, !90% necrosis is associated with a high probability of systemic relapse.…”

Trends in presentation of bone and soft tissue sarcomas over 25 years: little evidence of earlier diagnosis

“…[7][8][9] Patients who have small tumours or who are free of metastasis at diagnosis have an increased survival rate and the chance of survival is increased with more rapid diagnosis. 10 The prognosis for any one individual is determined by a combination of many factors including the effectiveness of treatment and response to chemotherapy when it is used.…”

Proximal femur reconstruction using a vascularized fibular epiphysis within a cadaveric femoral allograft in a child with Ewing sarcoma: a case report

“…This patient underwent neoadjuvant chemotherapy, which has been shown to be effective in shrinking tumor size and allowing a closer margin than would be considered safe in a tumor without this treatment [17,18] . It is known that vascularized fibular autografts are a preferred reconstruction material due to their osteogenic capacity and resistance to infection, chemotherapy, and radiotherapy [5,19,20] .…”