Osteosarcoma in Children

Abstract

Multimodal, limb-saving therapy is the treatment of choice in children with osteosarcoma. However, few data are available on long-term functional problems and disabilities in surviving patients. Seventy-eight children treated for Stage II-B osteosarcoma who were treated between 1970 and 1997 were evaluated. Beyond the clinical examination, functional results were assessed using the scoring system of the Musculoskeletal Tumor Society. Patients reported their physical disabilities when completing the Toronto Extremity Salvage Score. The most recent cohort of patients who had tumor resection combined with preoperative and postoperative chemotherapy had the best 10-year survival rate at 70%. Thirtyfour children (44%) were treated by limb-sparing therapy with 25 children requiring an endoprosthesis. Ten of these 25 children (40%) required one or in some cases several replacements of the endoprostheses because of complications. The original prostheses were in place for a median of 4.9 years before the first exchange (range, 2.0-12.0 years). Evaluations with rating scales showed that the subjective estimation of disabilities by the Toronto Extremity Salvage Score was significantly higher than a rating of limb functions by a doctor using the Musculoskeletal Tumor Society score. Best results were observed in children with an endoprosthesis of the distal femur who achieved as much as 90% ability to do their daily life routine. Limb-saving therapy in children with osteosarcoma enables a return to activities of daily living in long-term survivors with a minimum of remaining disability.

Avaliação funcional dos pacientes portadores de sarcomas ósseos submetidos à tratamento cirúrgico utilizando a endoprótese total ou parcial, na substituição da extremidade distal do fêmur

“…In the case series studied, there was a higher number of female patients (61.5%) compared to male patients (38.5%), a finding that is consistent to data published by other researchers (18,19,20) . However, we also found studies in which male gender was prevalent (3,9,15) . We found a prevalence of Caucasian ethnicity, accounting for 80.8% of the cases, consistently with other literature reports (18,19) .…”

“…Problems associated to limbs length asymmetry may occur, as well as complications inherent to orthopaedic implants, such as infections, aseptic loosening, wearoffs, breaks, and joint degeneration, which imply on reviews. In children, this kind of prosthesis' duration is even shorter, due to the high levels of physical activity found in this age group, high biomechanical demand, and to medullary channel remodeling, leading to intramedullary nail fixation loss (9,13) . The objective of this study was to retrospectively assess the functional outcomes in patients with femoral distal end sarcoma, submitted to reconstruction with total knee endoprosthesis, and compare them to those submitted to reconstruction with partial endoprosthesis.…”

“…Few studies assessed functional outcomes in patients with bone sarcomas at the femoral distal end and reconstructed with knee endoprostheses within the same age group as the patients in this study (3,9,15,16,17) , thus regarded as skeletically immature. In the case series studied, there was a higher number of female patients (61.5%) compared to male patients (38.5%), a finding that is consistent to data published by other researchers (18,19,20) .…”

“…to late amputations, even in the absence of local neoplasic disease relapse (7,8,9) . This, combined with continuous prostheses reviews, have led some surgeons to prefer amputation to conservative surgery in patients younger that 6 years old, making ablation surgery the most commonly employed technique in this age group (10) .…”

“…Although the case series is small, we can infer that both groups were at similar bone growth periods, thus the functional differences found cannot be attributed to age differences. The postoperative follow-up time constitutes another factor that could influence the functional outcomes of reconstructions with endoprostheses due to reviews caused by biomechanical complications (9,12) . From the functional point of view, the minimum postoperative follow-up time of 12 months allowed for an appropriate assessment of results.…”