Treatment of primary malignant bone tumours of the distal tibia

Laitinen, Minna; Hardes, Jendrik; Ahrens, H.; Gebert, Carsten; Leidinger, Benedikt; Langer, Martin; Winkelmann, Winfried; Gosheger, Georg

doi:10.1007/s00264-005-0656-4

Cited by 28 publications

(58 citation statements)

References 17 publications

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“…Other series [12, 16, 18] have had similar results between limb salvage and amputation for osteosarcoma of the distal tibia. However, the sample sizes in those studies are relatively smaller and comparisons were performed mostly between different types of reconstructions after limb salvage.…”

Section: Discussionmentioning

confidence: 71%

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Is Limb Salvage With Microwave-induced Hyperthermia Better Than Amputation for Osteosarcoma of the Distal Tibia?

Han

Dang

Bian

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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BackgroundAmputation has been the standard surgical treatment for distal tibia osteosarcoma owing to its unique anatomic features. Preliminary research suggested that microwave-induced hyperthermia may have a role in treating osteosarcoma in some locations of the body (such as the pelvis), but to our knowledge, no comparative study has evaluated its efficacy in a difficult-to-treat location like the distal tibia.QuestionsDoes microwave-induced hyperthermia result in (1) improved survival, (2) decreased local recurrence, (3) improved Musculoskeletal Tumor Society (MSTS) scores, or (4) fewer complications than amputation in patients with a distal tibial osteosarcoma?MethodsBetween 2000 and 2015, we treated 79 patients for a distal tibia osteosarcoma without metastases. Of those, 52 were treated with microwave-induced hyperthermia, and 27 with amputation. Patients were considered eligible for microwave-induced hyperthermia if they had an at least 20-mm available distance from the tumor edge to the articular surface, good clinical and imaging response to neoadjuvant chemotherapy, and no pathologic fracture. Patients not meeting these indications were treated with amputation. In addition, if neither the posterior tibial artery nor the dorsalis pedis artery was salvageable, the patients were treated with amputation and were not included in any group in this study. A total of 13 other patients were treated with conventional limb-salvage resections and reconstructions (at the request of the patient, based on patient preference) and were not included in this study. All 79 patients in this retrospective study were available for followup at a minimum of 12 months (mean followup in the hyperthermia group, 79 months, range 12–158 months; mean followup in the amputation group, 95 months, range, 15–142 months). With the numbers available, the groups were no different in terms of sex, age, tumor grade, tumor stage, or tumor size. All statistical tests were two-sided, and a probability less than 0.05 was considered statistically significant. Survival to death was evaluated using Kaplan-Meier analysis. Complications were recorded from the patients’ files and graded using the classification of surgical complications described by Dindo et al.ResultsIn the limb-salvage group, Kaplan Meier survival at 6 years was 80% (95% CI, 63%–90%), and this was not different with the numbers available from survivorship in the amputation group at 6 years (70%; 95% CI, 37%–90%; p = 0.301).With the numbers available, we found no difference in local recurrence (six versus 0; p = 0.066). However mean ± SD MSTS functional scores were higher in patients who had microwave-induced hyperthermia compared with those who had amputations (85% ± 6% versus 66% ± 5%; p = 0.008).With the numbers available, we found no difference in the proportion of patients experiencing complications between the two groups (six of 52 [12%] versus three of 27 [11%]; p = 0.954).ConclusionsWe were encouraged to find no early differences in survival, local recurrence, or serious compl...

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Section: Discussionmentioning

confidence: 71%

“…Historically, it has been very difficult to achieve satisfactory oncologic results and function with limb salvage in this anatomic location because of its particular challenges [12, 16, 18]. It has been reported that transtibial amputation provides a low risk of local recurrence and satisfactory function [2].…”

Section: Discussionmentioning

confidence: 99%

Is Limb Salvage With Microwave-induced Hyperthermia Better Than Amputation for Osteosarcoma of the Distal Tibia?

Han

Dang

Bian

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…An elevated survival rate was obtained with osteoarticular allograft (77 %), similar to other allograft types; however, they presented the highest complication rate (44 %) including fractures, infections local recurrences, and fractures. Reconstruction of defects after tumor resections of the distal tibia has been performed using allografts [33,34], autografts [35,36], and endoprostheses [37,38], although the reports included limited number of cases due to its low incidence [39,40]. Of the eight distal tibia OA in our series, five had complications: three articular failure (two required arthrodesis), one fracture and one local recurrence (required amputation).…”

Section: Discussionmentioning

confidence: 95%

Structural allograft reconstruction of the foot and ankle after tumor resections

et al. 2016

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“…But conflicting results have been reported regarding survival and function after limb salvage and amputation for patients with low-grade osteosarcoma of the distal tibia. [13,14] Several studies reported the survival rates after limb-salvage range from 100% to 50% at 6-288 months, [15,16] whereas those for amputation range from 100% to 84% at 36-60 months. [4,17] Thus, whether the relapse, 5-year survival and metastasis the same or not between limb-salvage and amputation in the treatment of patients with limited stage EnnekingⅡpathologic fracture osteosarcoma was not known.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of limb-salvage versus amputation in the treatment of patients with Enneking‡U pathologic fracture osteosarcoma

Jiang

Shi

et al. 2014

Indian J Cancer

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Treatment of primary malignant bone tumours of the distal tibia

Cited by 28 publications

References 17 publications

Is Limb Salvage With Microwave-induced Hyperthermia Better Than Amputation for Osteosarcoma of the Distal Tibia?

Is Limb Salvage With Microwave-induced Hyperthermia Better Than Amputation for Osteosarcoma of the Distal Tibia?

Structural allograft reconstruction of the foot and ankle after tumor resections

A meta-analysis of limb-salvage versus amputation in the treatment of patients with Enneking‡U pathologic fracture osteosarcoma

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