Abstract
Background Although not all children can be cured yet, much more emphasis is placed on the quality of life during and after cancer treatment. In the case of recurrence, mutilating treatment is still the prevalent option. In our study, we explored the role of limb salvage surgery for young patients with metastatic malignant bone tumors after endoprosthesis reconstruction during the first line of treatment and evaluated the impact of the local control modality in disease control and functional outcomes. Materials and Methods Eleven patients with bone tumor treated between 2007 and 2018 were included in this study. Both during primary treatment and during recurrence, limb salvage surgery was performed using a modular or expandable custom-made replacement system. Peri- and postoperative care for both surgeries were similar. All patients were given chemotherapy before and after both surgeries, according to the oncological guidelines. Results Seven patients (63.6%) are alive with a median follow-up of 6.5 years from diagnosis. None had local recurrence. Five-year estimates of event-free survival and overall survival were 36.27% and 79.55%, respectively. Median time between the first and second surgery was 2.7 years. Three patients presented with postoperative complications following both surgeries and required resurgical intervention. Three months following the second surgery, the Musculoskeletal Tumor Society Scale (MSTS) scores were 15–27 points (21 points on average—60%). Conclusions Limb salvage surgery is feasible and offers good chance of cure with a reasonable rate of complications and good function in patients with recurrent bone sarcoma after endoprosthesis reconstruction during the first line of treatment.
Highlights
Over the years, there has been tremendous progress in the treatment of cancer in children and adolescents
Recurrent osteosarcoma occurs in 30–50% of patients with initially localized disease and 80% of patients presenting with metastatic disease. e recurrence rate in Ewing sarcoma (ES) is comparable, with treatment failure seen in 50%–80% of patients depending on the site of metastases. e most common sites are the lungs
Factors influencing the results of treatment include the time of recurrence, response to CHT, and resectability of recurrence. e outcome was significantly better for patients who relapsed after having achieved complete remission than for patients who progressed to initial therapy
Summary
There has been tremendous progress in the treatment of cancer in children and adolescents. We explored the role of limb salvage surgery for young patients with metastatic malignant bone tumors after endoprosthesis reconstruction during the first line of treatment and evaluated the impact of the local control modality in disease control and functional outcomes. Eleven patients with bone tumor treated between 2007 and 2018 were included in this study Both during primary treatment and during recurrence, limb salvage surgery was performed using a modular or expandable custom-made replacement system. Ree patients presented with postoperative complications following both surgeries and required resurgical intervention. Limb salvage surgery is feasible and offers good chance of cure with a reasonable rate of complications and good function in patients with recurrent bone sarcoma after endoprosthesis reconstruction during the first line of treatment
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