Bone cancer or bone sarcoma is a very rare tumour of the bone. Until quite recently, amputation was inevitably required to treat such tumours. But doctors at the Cape Orthopaedic Reconstructive Unit (CORU) are taking big strides in the treatment of bone sarcoma with limb-sparing techniques.
Before 1970 bone sarcomas had a dismal survival rate and amputation was the standard surgical treatment. With the new advances in chemotherapy, imaging techniques, and microsurgical reconstruction, limb-sparing surgery is possible without compromising outcome and survival. Limb-sparing surgery is possible in 85% of bone sarcomas involving an arm or leg.
Dr Hosking has established a center of excellence in bone cancer care in South Africa at the Cape Orthopaedic Reconstructive Unit. The Cape Town based unit has a dedicated multidisciplinary team of sarcoma specialists which include orthopaedic cancer surgeons, plastic surgeons, specialist anaesthetists, oncologists, radiologists and pathologists.
WHAT IS LIMB-SPARING SURGERY?
Limb-sparing surgery offers an alternative to amputation. It is done by removing the tumour-affected area and reconstructing it using specialized surgical techniques. The type of reconstruction depends on the patients’ age, the potential growth of the bone, the area affected, the size of the tumour and the nature of the sarcoma.
RECONSTRUCTIVE OPTION IN LIMB-SPARING SURGERY:
• A vascularised fibular flap uses the fibular bone to reconstruct the affected arm or leg. The
fibula is the smaller of the two bones in the lower leg. The fibular is removed with its blood
supply and transplanted to the affected area using microsurgical techniques.
• Endoprosthetic replacement uses custom made titanium bone or joint replacement to
reconstruct a defect in a bone or joint.
• Bone transplantation uses a piece of bone from the patient’s body, normally the hip, or a
cadaver donor bone, to replace the bone that is missing after removal of the tumour.
• Sometimes combination procedures are needed.
“What is of utmost importance is that the most effective technique of reconstruction with the lowest complication rate is used, because a delay in resumption of is associated with a poorer prognosis”, explains Dr Hosking. Sometimes limb-sparing surgery is not feasible. In such cases customised amputation is performed to maximise functionality.
FACTS ABOUT SARCOMA
Sarcomas are tumours that grow in connective tissue. These are cells that connect or support
other kinds of tissue in your body. Sarcomas are divided into two main groups: Soft tissue sarcoma and Bone sarcoma. Bone sarcoma originates from mutations in bone or cartilage cells. It often occurs in the arms or legs. The most common area affected by bone sarcoma is the around the knee. Sarcoma is 15-20 times more common in children than in adults.
Sarcomas are rather elusive as they can occur anywhere and there are no specific tests for early detection. Early symptoms can be:
• joint stiffness
• bone pain at night
• limping (if the leg is affected)
Early detection and management plays an important role in outcome and therefor early referral to a dedicated center is recommended. Treatment of bone sarcoma is with a combination of surgery to remove the tumour, chemotherapy and sometimes radiation.
Sarcomas are very rare and this is why there are very few centers dedicated to limb-sparing
surgery and management of sarcomas in South Africa. To read more about sarcoma care, have a look at the Cape Orthopaedic Reconstructive Unit website.
Massive bone loss around the knee – the orthopaedic oncological perspective.
K Hosking FCOrth, MBChB. (UCT)Orthopaedic Surgeon, Groote Schuur Hospital and Life Orthopaedic Hospital (SA). Department of Orthopaedic Surgery, University of Cape Town