Limb-Sparing Surgery–Orthopedic Oncology Program

from Practice Update, Summer 2004

Osteosarcoma, right femur. Preoperative

Each year, nearly 2,400 American children are diagnosed with bone cancer. A vast majority of these kids will survive the disease, but a cure can come with a price—their limbs. Limb-sparing surgery is now an effective treatment for many, if not most, young patients with bone or soft tissue tumors. Limb-sparing surgery removes the tumor and preserves limb function. Today, a 90% prosthetic survival rate at ten years at most anatomic sites can be expected, with an overall limb salvage rate between 90-95%. Although The Children’s Hospital has long been recognized as a leader in pediatric cancer treatment and a regional and national leader in pediatric orthopedic surgery, with the addition of Travis Heare, MD, a focused program of musculoskeletal tumor surgery has been established.

A decade ago, childhood bone cancers, such as osteosarcoma, Ewings’s sarcoma, or benign bone and soft tissue tumors of the extremities, often meant amputation. Over the last twenty years, strides in both surgical oncology and adjuvant chemotherapy have reduced amputation rates from 90% to less than ten percent. Studies confirm the clinical and pathologic analysis of limb-sparing surgery. Dr Heare explains, “Limb-sparing surgery, including bone grafts, bone prosthetics or a combination of the two, used in conjunction with new advances in chemotherapy and radiation therapy have been shown to be as effective as amputation in mitigating cancer and has the added advantage of keeping kids out of wheelchairs and off crutches.”

Accompanying pathologic fracture

Preoperative treatment with chemotherapeutic agents can reduce neovascularity and maximize tumor response prior to surgery. Advances in bone prosthetics have improved the longevity of reconstructions and added options that accommodate childhood and adolescent bone growth.

Special Considerations of the Pediatric Patient

The multidisciplined orthopedic oncology program at Children’s offers young patients the broadest range of therapies in the region. “Because epiphyses are open and cartilaginous, tendons are still growing and bones are not completely ossified, limb-sparing surgery in children is more complicated than in adults. Because children are active, repairs are subject to diverse, high degrees of stress. At Children’s we have extensive resources and expertise in treating kids with limb-threatening cancers. My colleagues in pediatric oncology, radiation therapy, rehabilitation, nursing, pathology, psycho-social counseling and nutrition work closely with our surgical team to treat kids and support parents and families throughout the continuum of care,” said Dr. Heare.

Even in cases where amputation is necessary, physical therapy programs and resources, such as the Center for Gait and Movement, extensive pediatric physical therapy services and pediatric prosthetics and orthotics give kids a chance at the best prognosis.

Prosthetic reconstruction

More Than Surgery

The orthopedic oncology program at Children’s is comprehensive and specific to the pediatric patient and their family. A diagnosis of bone or soft tissue cancer is complex. The involvement of numerous pediatric specialists ensures the best prognosis. Dr. Heare gives a number of examples, “The ability to involve a pediatric nutritionist in preoperative adjuvant therapies helps kids maintain their appetites and maintain their strength through surgery and post-operative rehabilitation. Our pediatric oncologists are some of the best in the country. They treat only children, so they know best the intricacies and complexities of issues that can result from childhood chemotherapy and radiation. We have a pain service specific to kids’ needs. They know that children experience pain differently and may have consequent changes in behavior, eating and sleeping patterns following surgery. Surgical expertise is only a part of the equation that equals a bright future for kids with limb-threatening sarcomas. Our team at Children’s works together to get kids back to school and extracurricular activities, back to being just kids.”