Bone and soft tissue sarcomas are often curable—But at what cost?

Abstract

Even if the number of amputations per year has decreased with time, limb salvage surgery may not offer a better functional outcome and health‐related quality of life for young people with bone and soft tissue sarcomas of the lower limb.

En bloc resection and prosthesis implantation to treat malignant fibrous histiocytoma of the humerus

“…12 Limb salvage surgery patients have better quality of life without compromising survival than those who have undergone amputation. [13][14][15] Developments in adjuvant therapies, imaging diagnostics and surgical reconstructive techniques have made limb salvage surgery a preferred procedure for most primary sarcomas of the upper limbs with survival rates of 60-70%. 16,17 Today, major amputations are avoidable in most cases if the full potential of reconstructive possibilities is tapped.…”

(i) Osteosarcoma

“…35 Although limb-salvage has become widely accepted, it is important to appreciate that it is not necessarily associated with a better functional outcome or health related quality of life than amputation for some patients with lower limb tumours. 36 Although historically amputation is associated with slightly lower functional scores, it is likely that these will improve with new developments in the field of prosthetics. For example, the intraosseous transcutaneous amputation prosthesis (ITAP) (Stanmore Implants Worldwide Ltd) allows direct attachment of limb prostheses to the appendicular skeleton through the use of a bone anchor, onto which the skin grows, providing a barrier to the entry of microorganisms.…”

How PET/MR Can Add Value for Children with Cancer

“…Overestimating tumor size can lead to unnecessary surgical resections of too much normal tissue, affect the approach for limb-sparing surgery and lead to unsatisfactory long-term outcomes [70, 73]. Conversely, incomplete tumor resection can impact prognosis and post-surgical care [74–76]: In Ewing sarcomas, a wide surgical margin (R0) with normal tissue around the lesion does not require additional local control while a marginal excision (R1), which includes tumor cells at the cut surface, must be treated by radiotherapy and/or intensified chemotherapy [77]. Recent evidence shows that 18 F-FDG-PET can help differentiating tumor tissue and peri-lesional edema: The primary tumor shows marked 18 F-FDG uptake while peri-lesional edema shows little or no 18 F-FDG uptake [78] (Fig.…”