Skip to main content

Pediatric Patients with Bone Malignancy: Therapeutic Options

  • Chapter
  • First Online:
  • 1619 Accesses

Part of the book series: Pediatric Cancer ((PECA,volume 4))

Abstract

Primary bone malignancy, namely osteosarcoma and Ewing sarcoma, is predominantly encountered in the pediatric population. After histological confirmation of diagnosis done through a carefully performed biopsy these malignant tumors are generally treated with neoadjuvant chemotherapy and wide surgical resection, followed by adjuvant chemotherapy. Reconstructive options after resection depend on tumor size and location as well as patient age and goals. Limb ablation, either by amputation or rotationplasty, is commonly a less appealing option although the literature supports excellent long-term outcomes and durability. As a result of improved neoadjuvant regimens limb sparing surgery has become the mainstay of surgical treatment for the vast majority of bone tumors. Limb sparing options primarily include allograft reconstruction, allograft prosthetic composite reconstruction, and megaprosthesis reconstruction with or without expansion capabilities. Each of these options has features that make them attractive as well as potential complications. The choice of reconstruction should be made after in-depth discussion of the benefits, alternatives and potential complications on a patient by patient basis.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  • Abdeen A, Hoang BH, Athanasian EA, Morris CD, Boland PJ, Healey JH (2009) Allograft-prosthesis composite reconstruction of the proximal part of the humerus: functional outcome and survivorship. J Bone Joint Surg Am 91:2406–2415

    Article  PubMed  Google Scholar 

  • Balke M, Ahrens H, Streitburger A, Gosheger G, Hardes J (2009) Modular endoprosthetic reconstruction in malignant bone tumors: indications and limits. Recent Results Cancer Res 179:39–50

    Article  PubMed  Google Scholar 

  • Baumgart R, Hinterwimmer S, Krammer M, Muensterer O, Mutschler W (2005) The bioexpandable prosthesis: a new perspective after resection of malignant bone tumors in children. J Pediatr Hematol Oncol 27:452–455

    Article  PubMed  Google Scholar 

  • Berrey BH, Lord CF, Gebhardt MC, Mankin HJ (1990) Fractures of allografts: frequency, treatment and end-results. J Bone Joint Surg Am 72:825–833

    PubMed  Google Scholar 

  • Campanacci L, Manfini M, Colangeli M, Ali N, Mercuri M (2010) Long-term results in children with massive bone osteoarticular allografts of the knee for high-grade osteosarcoma. J Pediatr Orthop 30:919–927

    Article  PubMed  Google Scholar 

  • DiCaprio MR, Friedlaender GE (2003) Malignant bone tumors: limb sparing versus amputation. J Am Acad Orthop Surg 11(1):25–37

    PubMed  Google Scholar 

  • Eckardt JJ, Safran MR, Eilber FR, Rosen G, Kabo JM (1993) Expandable endoprosthetic reconstruction of the skeletally immature after malignant bone tumor resection. Clin Orthop Relat Res 297:188–202

    PubMed  Google Scholar 

  • Eckardt JJ, Kabo JM, Kelley CM, Ward WG Sr, Asavamongkolkul A, Wirganowicz PZ, Yang RS, Eilber FR (2000) Expandable endoprosthesis reconstruction in skeletally immature patients with tumors. Clin Orthop Relat Res 373:51–61

    Article  PubMed  Google Scholar 

  • Enneking WF, Campanacci DA (2001) Retrieved human allografts: a clinicopathological study. J Bone Joint Surg Am 83:971–986

    PubMed  Google Scholar 

  • Gilbert NF, Yasko AW, Oates SD, Lewis VO, Cannon CP, Lin PP (2009) Allograft-prosthetic composite reconstruction of the proximal part of the tibia: an analysis of the early results. J Bone Joint Surg Am 91:1646–1656

    Article  PubMed  Google Scholar 

  • Gitelis S, Neel MD, Wilkins RM, Rao BN, Kelly CM, Yao TK (2003) The use of a closed expandable prosthesis for pediatric sarcomas. Chir Organi Mov 88:327–333

    PubMed  CAS  Google Scholar 

  • Glasser DB, Duane K, Lane JM, Healey JH, Caparros-Sison B (1991) The effect of chemotherapy on growth in the skeletally immature individual. Clin Orthop Relat Res 262:93–100

    PubMed  Google Scholar 

  • Gottsauner-Wolf F, Kotz R, Knahr K, Kristen H, Ritschl P, Salzer M (1991) Rotationplasty for limb salvage in the treatment of malignant tumors at the knee. A follow-up study of seventy patients. J Bone Joint Surg Am 73:1365–1375

    PubMed  CAS  Google Scholar 

  • Hanlon M, Krajbich JI (1999) Rotationplasty in skeletally immature patients. Long-term followup results. Clin Orthop Relat Res 358:75–82

    Article  PubMed  Google Scholar 

  • Hillmann A, Hoffmann C, Gosheger G, Krakau H, Winkelmann W (1999) Malignant tumor of the distal part of the femur or the proximal part of the tibia: endoprosthetic replacement or rotationplasty. Functional outcome and quality-of-life measurements. J Bone Joint Surg Am 81:462–468

    Article  PubMed  CAS  Google Scholar 

  • Hopyan S, Tan JW, Graham HK, Torode IP (2006) Function and upright time following limb salvage, amputation, and rotationplasty for pediatric sarcoma of bone. J Pediatr Orthop 26(3):405–408

    Article  PubMed  Google Scholar 

  • Kenan S (1999) Limb-sparing of the lower extremity by using the expandable prosthesis in children with malignant bone tumors. Operative Techniques in Orthopaedics 9:101–7

    Article  Google Scholar 

  • Kotz R (1997) Rotationplasty. Semin Surg Oncol 13:34–40

    Article  PubMed  CAS  Google Scholar 

  • Kropej D, Schiller C, Ritschl P, Salzer-Kuntschik M, Kotz R (1991) The management of IIB osteosarcoma. Experience from 1976 to 1985. Clin Orthop Relat Res 270:40–44

    PubMed  Google Scholar 

  • Kumta SM, Cheng JC, Li CK, Griffith JF, Chow LT, Quintos AD (2002) Scope and limitations of limb-sparing surgery in childhood sarcomas. J Pediatr Orthop 22:244–248

    PubMed  Google Scholar 

  • Lewis MM (1986) The use of an expandable and adjustable prosthesis in the treatment of childhood malignant bone tumors of the extremity. Cancer 57:499–502

    Article  PubMed  CAS  Google Scholar 

  • Mankin JH, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW (1996a) Long-term results of allograft replacement in the management of bone tumors. Clin Orthop Relat Res 324:86–97

    Article  PubMed  Google Scholar 

  • Mankin HJ, Mankin CJ, Simon MA (1996b) The hazards of the biopsy, revisited. For the members of the musculoskeletal tumor society. J Bone Joint Surg Am 78:656–663

    PubMed  CAS  Google Scholar 

  • Neel MD, Wilkins RM, Rao BN, Kelly CM (2003) Early multicenter experience with a noninvasive expandable prosthesis. Clin Orthop Relat Res 415:72–81

    Article  PubMed  Google Scholar 

  • Nystrom LM, Morcuende JA (2010) Expanding endoprostheses for pediatric musculoskeletal malignancy: current concepts and results. Iowa Orthop J 30:141–149

    PubMed  Google Scholar 

  • Reach JS, Dickey ID, Zobitz ME, Adams SP, Scully SP, Lewallen DG (2007) Direct tendon attachment and healing to porous tantalum: an experimental animal study. J Bone Joint Surg Am 89:1000–1009

    Article  PubMed  Google Scholar 

  • Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ (1994) Limb salvage compared with amputation for osteosarcoma of the distal end of the femur. A long-term oncological, functional and quality-of-life study. J Bone Joint Surg Am 76:649–656

    PubMed  CAS  Google Scholar 

  • Schiller C, Windhager R, Fellinger EJ, Salzer-Kuntschik M, Kaider A, Kotz R (1995) Extendable tumour endoprostheses for the leg in children. J Bone Joint Surg Br 77–4:608–614

    Google Scholar 

  • Schindler OS, Cannon SR, Briggs TW, Blunn GW (1997) Stanmore custom-made extendible distal femoral replacements. Clinical experience in children with ­primary malignant bone tumours. J Bone Joint Surg Br 79–6:927–937

    Article  Google Scholar 

  • Schindler OS, Cannon SR, Briggs TW, Blunn GW, Grimer RJ, Walker PS (1998) Use of extendable total femoral replacements in children with malignant bone tumors. Clin Orthop Relat Res 357:157–170

    Article  PubMed  Google Scholar 

  • Simon MA, Aschliman MA, Thomas N, Mankin HJ (1986) Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur. J Bone Joint Surg Am 68–9:1331–1337

    Google Scholar 

  • Sluga M, Windhager R, Lang S, Heinzl H, Bielack S, Kotz R (1999) Local and systemic control after ablative and limb sparing surgery in patients with osteosarcoma. Clin Orthop Relat Res 358:120–127

    Article  PubMed  Google Scholar 

  • Tunn PU, Schmidt-Peter P, Pomraenke D, Hohenberger P (2004) Osteosarcoma in children: long-term functional analysis. Clin Orthop Relat Res 421:212–217

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jose A. Morcuende .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Nystrom, L.M., Morcuende, J.A. (2013). Pediatric Patients with Bone Malignancy: Therapeutic Options. In: Hayat, M. (eds) Pediatric Cancer, Volume 4. Pediatric Cancer, vol 4. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6591-7_31

Download citation

Publish with us

Policies and ethics