Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2018

Open Access 01-12-2018 | Research article

The multidisciplinary treatment of osteosarcoma of the proximal tibia: a retrospective study

Authors: Junqi Huang, Wenzhi Bi, Gang Han, Jinpeng Jia, Meng Xu, Wei Wang

Published in: BMC Musculoskeletal Disorders | Issue 1/2018

Login to get access

Abstract

Background

Survival and reconstruction constitute important challenges in multimodal treatment of osteosarcoma of the proximal tibia. The purpose of this study was to assess the efficacy and prognosis of neoadjuvant chemotherapy and custom-designed endoprosthetic arthroplasty.

Methods

A total of 69 patients with osteosarcoma of the proximal tibia were evaluated, including 43 males and 26 females, treated with multidisciplinary limb-salvage remedy from October 2003 to December 2013. They were at least 12 years old (mean, 20 years; range, 12–57 years). The gap between tumor and main artery/nerve was showed in MRI. Mean follow up was 69.5 months (range, 9–144 months). Kaplan-Meier survival curves were generated to assess prognosis and relapse rate. The initial symptoms and disease duration for each patient were recorded. Correlation analyses were performed for the association of various parameters with prognosis. Functional outcomes were evaluated using the Musculoskeletal Tumor Society (MSTS) guidelines after 6 months postoperatively, to analyze the relation between bone excision size and function recovery.

Results

The resection lengths measured intraoperatively ranged from 80 to 230 mm, and contained 3 cm of normal bone around the tumor. A total of 3 courses of preoperative chemotherapy were administered to all cases. At final follow-up, 1 case showed recurrence. Meanwhile, 8 patients (11.6%) died from lung metastasis. Post-operative infection occurred in 3 patients; 1 case was maintained with revision surgery. Two cases underwent amputation. The mean MSTS system score was 21.6.

Conclusions

The multidisciplinary treatment result in an overall positive outcome, with improved function.
Literature
1.
Ene R, Sinescu RD, Ene P, Popescu D, Cirstoiu MM, Cirstoiu FC. Proximal tibial osteosarcoma in young patients: early diagnosis, modular reconstruction. Rom J Morphol Embryol. 2015;56(2):413–7.PubMed
2.
Stiller CA, Bielack SS, Jundt G, Steliarova-Foucher E. Bone tumours in European children and adolescents, 1978-1997. Report from the automated childhood Cancer information system project. Eur J Cancer. 2006;42(13):2124–35.CrossRefPubMed
3.
Sohn JH, Rha SY, Jeung HC, et al. Efficacy of pre- and postoperative chemotherapy in patients with osteosarcoma of the extremities. Cancer Res Treat. 2001;33(6):520–6.CrossRefPubMed
4.
Ritter J, Bielack SS. Osteosarcoma. Ann Oncol. 2010;21(Suppl 7):vii320–5.PubMed
5.
Zhang Y, Yang Z, Li X, et al. Custom prosthetic reconstruction for proximal tibial osteosarcoma with proximal tibiofibular joint involved. Surg Oncol. 2008;17(2):87–95.CrossRefPubMed
6.
Veth R, van Hoesel R, Pruszczynski M, Hoogenhout J, Schreuder B, Wobbes T. Limb salvage in musculoskeletal oncology. Lancet Oncol. 2003;4(6):343–50.CrossRefPubMed
7.
Dai X, Ma W, He X, Jha RK. Review of therapeutic strategies for osteosarcoma, chondrosarcoma, and Ewing's sarcoma. Med Sci Monit. 2011;17(8):RA177–90.CrossRefPubMedPubMedCentral
8.
Ando K, Heymann MF, Stresing V, Mori K, Redini F, Heymann D. Current therapeutic strategies and novel approaches in osteosarcoma. Cancers (Basel). 2013;5(2):591–616.CrossRef
9.
10.
Anract P, Missenard G, Jeanrot C, Dubois V, Tomeno B. Knee reconstruction with prosthesis and muscle flap after total arthrectomy. Clin Orthop Relat Res. 2001;384:208–16.CrossRef
11.
Biau DJ, Dumaine V, Babinet A, et al. Allograft prosthesis composites after bone tumor resection at the proximal tibia. Clin Orthop Relat Res. 2007;456:211–7.CrossRefPubMed
12.
Dubousset J, Missenard G, Kalifa C. Management of osteogenic sarcoma in children and adolescents. Clin Orthop Relat Res. 1991;(270):52–9.
13.
Marulanda GA, Henderson ER, Johnson DA, Letson GD, Cheong D. Orthopedic surgery options for the treatment of primary osteosarcoma. Cancer Control. 2008;15(1):13–20.CrossRefPubMed
14.
Campanacci L, Manfrini M, Colangeli M, Ali N, Mercuri M. Long-term results in children with massive bone osteoarticular allografts of the knee for high-grade osteosarcoma. J Pediatr Orthop. 2010;30(8):919–27.CrossRefPubMed
15.
Hogendoorn PC, Group EEW, Athanasou N, et al. Bone sarcomas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(Suppl 5):v204–13.CrossRefPubMed
16.
Arteau A, Lewis VO, Moon BS, Satcher RL, Bird JE, Lin PP. Tibial growth disturbance following distal femoral resection and expandable Endoprosthetic reconstruction. J Bone Joint Surg Am. 2015;97(22):e72.CrossRefPubMedPubMedCentral
17.
Capanna R, Scoccianti G, Campanacci DA, Beltrami G, De Biase P. Surgical technique: extraarticular knee resection with prosthesis-proximal tibia-extensor apparatus allograft for tumors invading the knee. Clin Orthop Relat Res. 2011;469(10):2905–14.CrossRefPubMedPubMedCentral
18.
Niimi R, Matsumine A, Hamaguchi T, Nakamura T, Uchida A, Sudo A. Prosthetic limb salvage surgery for bone and soft tissue tumors around the knee. Oncol Rep. 2012;28(6):1984–90.CrossRefPubMed
19.
Wittig JC, Villalobos CE, Hayden BL, Choi I, Silverman AM, Malawer M. Osteosarcoma of the proximal tibia: limb-sparing resection and reconstruction with a modular segmental proximal tibia tumor prosthesis. Ann Surg Oncol. 2010;17(11):3021.CrossRefPubMed
20.
Bi W, Wang W, Han G, Jia J, Xu M. Osteosarcoma around the knee treated with neoadjuvant chemotherapy and a custom-designed prosthesis. Orthopedics. 2013;36(4):e444–50.CrossRefPubMed
21.
Zeegen EN, Aponte-Tinao LA, Hornicek FJ, Gebhardt MC, Mankin HJ. Survivorship analysis of 141 modular metallic endoprostheses at early followup. Clin Orthop Relat Res. 2004;420:239–50.CrossRef
22.
Rosen G, Marcove RC, Caparros B, Nirenberg A, Kosloff C, Huvos AG. Primary osteogenic sarcoma: the rationale for preoperative chemotherapy and delayed surgery. Cancer. 1979;43(6):2163–77.CrossRefPubMed
23.
Ferrari S, Palmerini E. Adjuvant and neoadjuvant combination chemotherapy for osteogenic sarcoma. Curr Opin Oncol. 2007;19(4):341–6.CrossRefPubMed
24.
Hong S, Shin SJ, Jung M, et al. Comparison of long-term outcome between doublet and triplet neoadjuvant chemotherapy in non-metastatic osteosarcoma of the extremity. Oncology. 2011;80(1–2):107–17.CrossRefPubMed
25.
Mir O, Ropert S, Goldwasser F. Neoadjuvant chemotherapy with high-dose methotrexate in osteosarcoma. Lancet Oncol. 2008;9(12):1198.CrossRefPubMed
26.
Grimer RJ, Carter SR, Tillman RM, et al. Endoprosthetic replacement of the proximal tibia. J Bone Joint Surg Br. 1999;81(3):488–94.CrossRefPubMed
27.
Jeon DG, Kawai A, Boland P, Healey JH. Algorithm for the surgical treatment of malignant lesions of the proximal tibia. Clin Orthop Relat Res. 1999;358:15–26.CrossRef
28.
Ogihara Y, Sudo A, Fujinami S, Sato K. Limb salvage for bone sarcoma of the proximal tibia. Int Orthop. 1991;15(4):377–9.CrossRefPubMed
29.
Petschnig R, Baron R, Kotz R, Ritschl P, Engel A. Muscle function after endoprosthetic replacement of the proximal tibia. Different techniques for extensor reconstruction in 17 tumor patients. Acta Orthop Scand. 1995;66(3):266–70.CrossRefPubMed
30.
Bickels J, Wittig JC, Kollender Y, et al. Reconstruction of the extensor mechanism after proximal tibia endoprosthetic replacement. J Arthroplast. 2001;16(7):856–62.CrossRef
31.
Yoshida Y, Osaka S, Ryu J. Reconstruction of the knee extensor mechanism in patients with a malignant bone tumor of the proximal tibia. Surg Today. 2010;40(7):646–9.CrossRefPubMed
32.
Ayerza MA, Aponte-Tinao LA, Abalo E, Muscolo DL. Continuity and function of patellar tendon host-donor suture in tibial allograft. Clin Orthop Relat Res. 2006;450:33–8.CrossRefPubMed
33.
Shimose S, Sugita T, Kubo T, Matsuo T, Ochi M. Reconstructed patellar tendon length after proximal tibia prosthetic replacement. Clin Orthop Relat Res. 2005;439:176–80.CrossRefPubMed
34.
Jeys LM, Kulkarni A, Grimer RJ, Carter SR, Tillman RM, Abudu A. Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis. J Bone Joint Surg Am. 2008;90(6):1265–71.CrossRefPubMed
35.
Myers GJ, Abudu AT, Carter SR, Tillman RM, Grimer RJ. Endoprosthetic replacement of the distal femur for bone tumours: long-term results. J Bone Joint Surg Br. 2007;89(4):521–6.CrossRefPubMed
36.
Peel T, May D, Buising K, Thursky K, Slavin M, Choong P. Infective complications following tumour endoprosthesis surgery for bone and soft tissue tumours. Eur J Surg Oncol. 2014;40(9):1087–94.CrossRefPubMed
37.
Brock HS, Moodie PG, Hendricks KJ, McIff TE. Compression strength and porosity of single-antibiotic cement vacuum-mixed with vancomycin. J Arthroplast. 2010;25(6):990–7.CrossRef
38.
Yu XC, Xu M, Xu SF, Song RX. Long-term outcomes of epiphyseal preservation and reconstruction with inactivated bone for distal femoral osteosarcoma of children. Orthop Surg. 2012;4(1):21–7.CrossRefPubMed
39.
Aponte-Tinao L, Ayerza MA, Muscolo DL, Farfalli GL. Survival, recurrence, and function after epiphyseal preservation and allograft reconstruction in osteosarcoma of the knee. Clin Orthop Relat Res. 2015;473(5):1789–96.CrossRefPubMed
Metadata
Title
The multidisciplinary treatment of osteosarcoma of the proximal tibia: a retrospective study
Authors
Junqi Huang
Wenzhi Bi
Gang Han
Jinpeng Jia
Meng Xu
Wei Wang
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2018
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-018-2245-x

Other articles of this Issue 1/2018

BMC Musculoskeletal Disorders 1/2018 Go to the issue

Research article

Change in muscle volume after steroid therapy in patients with myositis assessed using cross-sectional computed tomography

Research article

Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) assessed with whole-spine computed tomography in 1479 subjects

Research article

The prevalence and under-diagnosis of vertebral fractures on chest radiograph

Study protocol

Above-versus below-elbow casting for conservative treatment of distal radius fractures: a randomized controlled trial and study protocol

Research article

Improving accuracy of opening-wedge osteotomies of distal radius using a patient-specific ramp-guide technique

Research article

Deep vein thrombosis following the treatment of lower limb pathologic bone fractures – a comparative study