Malignant bone tumors

Surgical treatment of malignant bone tumors

Excision through the perilesional reactive zone (marginal margin) is indicated for some selected patients who have a high or low-grade bone or soft-tissue sarcoma that has shown histological evidence of extensive necrosis in response to preoperative chemotherapy and radiation therapy. However, a higher prevalence of local recurrence can be expected in patients who have an excision through the perilesional reactive zone when no effective adjuvant treatment was administered preoperatively.

Wide margins are desirable for most bone and soft tissue sarcomas when the margins have been adequately defined by contemporary staging techniques such as MRI or CT scan. It’s the most reliable and safe margin in malignant bone tumors surgery provided no skip lesions.

It must be followed by skeletal reconstruction either through biological reconstruction or prosthetic replacement.

Radical resections, formerly the procedure of choice for most high-grade sarcomas, are now reserved for recurrent sarcomas, after a pathological fracture through the bone sarcoma or when the margins cannot be defined accurately. Radical resections therefore are infrequently used for musculoskeletal sarcomas at the present time.
 

Wide
resection of osteosarcoma of the distal femur
and reconstruction by modular knee prothesis
Wide
marginal resection of osteosarcoma of the proximal femur
and reconstruction by custom made hip  prothesis

Modular distal femur prothesis
Wide
marginal resection of osteosarcoma of the proximal femur
and reconstruction by custom made hip prothesis
X-ray showing different endoprothesis