Limb salvage in bone sarcomas in patients younger than age 10: a 20-year experience

Department of Orthopedic, University of Navarra, Pamplona, Spain.
Journal of Pediatric Orthopaedics (Impact Factor: 1.47). 01/2003; 23(6):753-62. DOI: 10.1097/00004694-200311000-00013
Source: PubMed


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.

Download full-text


Available from: Mikel San-Julian, Oct 04, 2015
1 Follower
26 Reads
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The feasibility of distal femur epiphysis preservation through epiphyseal distraction by external fixator in childhood osteosarcoma was explored. Methods Between July 2007 and May 2011, 10 children who were suffering from distal femur osteosarcoma received epiphyseal distraction by external fixator, combined with tumor resection and repair with massive allograft bone to preserve the epiphysis of the distal femur and knee function. There were six male and four female patients, 9- to 14-years old (average 10.5 years old). The tumors were staged clinically according to the Enneking staging method: six cases were classified as stage in IIA and four cases as stage in IIB. All patients were diagnosed by biopsy, then received chemotherapy before and after surgery. All patients received tumor bone resection and the defects of the bone were repaired with massive allograft bone that was fixed by intramedullary nails; the distracted epiphysis and allograft bone were fixed with cancellous screws. Results All cases received follow-up from 15 to 56 months (average 38.5 months). There were no local recurrences. One case died of lung metastasis and one case had poor incision healing for rejection of allograft bone. According to the functional evaluation criteria of the International Society of Limb Salvage (ISOLS) after operation, five cases were rated excellent, four cases good and one case fair. The ratio of excellent or good was 90.0%. There was no statistically significant difference in length between the operated and the normal lower limbs during the last review. Conclusions Epiphyseal distraction by external fixator can result in satisfactory limb length and joint function for children with a malignant bone tumor.
    World Journal of Surgical Oncology 08/2014; 12(1):251. DOI:10.1186/1477-7819-12-251 · 1.41 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Osteosarcoma is the most common solid tumour of childhood. Chemotherapy has substantially improved survival, but surgical resection remains essential for cure. Limb-salvage surgery is now common and can be done for up to 85% of children with osteosarcoma. The main surgical challenge in children is how to reconstruct the limb after removal of the tumour. Knowledge of probable outcomes, risks, and benefits of each surgical option is essential for comparison of reconstruction with amputation, which is still the safest and most suitable option in some children.
    The Lancet Oncology 03/2005; 6(2):85-92. DOI:10.1016/S1470-2045(05)01734-1 · 24.69 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Sarcomas of bone have a number of distinguishing features that set them apart from primary cancers of many other organ systems. First, they are extremely rare in comparison with other types of cancer, a fact that has impeded the ability of treatment in this field to evolve rapidly in an evidence-based manner because of the small numbers of patients available for studies. Progress in this field has been possible only with multicenter and oncology group trials that can provide sufficient numbers of patients for study. Even so, clinical trials are generally limited to prospective case series at best, and much of the literature is based on retrospective case series. True controlled randomized prospective trials are extremely rare. Nevertheless, a number of clinically useful observations defining the behavior of these tumors and their responses to treatments have derived from the analyses of the numerous case series that have been published, and these results and the associated levels of evidence are reviewed here.
    12/2005: pages 1034-1047;
Show more