Overview
Definition:
Treatment of malignant bone tumors most often consists of both chemotherapy and/or radiation, as well as surgery. Surgical techniques are rapidly improving, especially with the advancement of so-called limb salvage surgery.
As recently as 10 to 20 years ago, the surgical answer to aggressive tumors of the extremity was amputation. While this is necessary in certain cases today, many patients are treated with limb salvage, or limb sparing surgery, with similar results. These operations are designed to save the limb while removing the tumor. Special prostheses, bone grafts, and bone transplantation, are all techniques used in these surgeries.
Surgical Techniques
Bone Tumors :
Surgeons remove the malignant lesion and a cuff of normal tissue (wide excision) to cure low-grade tumors of bone or its components. To cure high-grade tumors, they also remove muscle, bone, and other tissues affected by the tumor (radical resection).
Soft Tissue Sarcomas :
Surgeons use limb-sparing surgery to treat about 80% of soft tissue sarcomas affecting extremities. The surgery removes the tumor, lymph nodes, or tissues to which the cancer has spread, and at least 1 in (2.54 cm) of healthy tissue on all sides of the tumor.
Radiation and/or chemotherapy may be administered before or after the operation. Radiation may also be administered during the operation by placing a special applicator against the surface from which the tumor has just been removed, and inserting tubes containing radioactive pellets at the site of the tumor. These tubes remain in place during the operation and are removed several days later.
To treat a soft tissue sarcoma that has spread to the patient's lung, the doctor may remove the original tumor, administer radiation or chemotherapy treatments to shrink the lung tumor, and surgically remove the lung tumor.
Diagnosis/Preparation
Before deciding that limb salvage is appropriate for a particular patient, the treating doctor considers what type of cancer the patient has, the size and location of the tumor, how the illness has progressed, and the patient's age and general health.
After determining that limb salvage is appropriate for a particular patient, the doctor makes sure that the patient understands what the outcome of surgery is likely to be, that the implant may fail, and that additional surgery—even amputation—may be necessary.
Physical and occupational therapists help prepare the patient for surgery by introducing the muscle-strengthening, ambulation (walking), and range of motion (ROM) exercises the patient will begin performing right after the operation.
Risks
The major risks associated with limb salvage are: superficial or deep infection at the site of the surgery; loosening, shifting, or breakage of implants; rapid loss of blood flow or sensation in the affected limb; and severe blood loss and anemia from the surgery.
Postoperative infection is a serious problem. Chemotherapy or radiation can weaken the immune system, and extensive bone damage can occur before the infection is identified. Tissue may die (necrosis) if the surgeon used a large piece of tissue (flap) to close the wound. This is most likely to occur if the surgical site was treated with radiation before the operation. Treatment for postoperative infection involves removing the graft or implant, inserting drains at the infected site, and giving the patient oral or intravenous (IV) antibiotic therapy for as long as 12 months. Doctors may have to amputate the affected limb.
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