EPIPHYSEAL DISTRACTION FOR PRESERVATION OF EPIPHYSIS OF OSTEOSARCOMA IN CHILDREN_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GAO Songtao , CAI Qiqing , YAO Weitao , WANG Jiaqiang , ZHANG Peng , WANG Chuangjian , WANG Xin.

Department of Orthopaedics, Henan Tumor Hospital, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou Henan, 450008, P.R.China. Corresponding author: CAI Qiqing, E-mail: caiqiqing@medmail.com.;

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Keywords：

Osteosarcoma; Epiphyseal distraction technique; Knee joint; External fixator

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Objective To investigate the feasibility of the preservation of the epiphysis and joint function of the distal femur in children with osteosarcoma with epiphyseal distraction by external fixator. Methods Between July 2007 and May 2011, 6 children with osteoblastic osteosarcoma of the distal femur underwent epiphyseal distraction by external fixator, combined with tumor resection and repair with massive allograft bone transplantation to preserve the epiphysis and joint function of the distal femur. There were 4 boys and 2 girls, aged from 9 to 14 years (mean, 10.5 years). According to Enneking clinical staging, 4 cases were in stage II A and 2 cases in stage II B. According to San-Julian et al. typing for metaphyseal tumor invasion, 3 cases were in type I and 3 cases in type II. The size of tumor ranged from 6 cm × 4 cm to 12 cm × 9 cm. All patients received 2 cycles of COSS 86 chemotherapy before operation and 4 cycles after operation. Results Poor healing of incision was observed in 1 case because of rejection of allograft bone and good healing was obtained after the symptomatic treatment, healing of incision by first intention was achieved in the other children. All 6 cases were followed up 11 to 56 months (mean, 37.5 months). One case died of lung metastasis at 2 years after operation. X-ray films showed no complication of internal fixator loosening and broken or bone nonunion. According to the functional evaluation criteria of International Society of Limb Salvage (ISOLS) at last follow-up, the results were excellent in 3 cases, good in 2 cases, and fair in 1 case; the excellent and good rate was 83.3%. The length of operated limb was (62.97 ± 7.51) cm, showing significant difference when compared with that of normal limb [(64.03 ± 7.47) cm] (t=0.246 6, P=0.813 4). Conclusion On the premise of adaptable indication, effective chemotherapy, and thoroughly tumor resection, the epiphyseal distraction by external fixator can obtain satisfactory results in limb-length and limb function in children with osteoblastic osteosarcoma of the distal femur.

Citation： GAO Songtao,CAI Qiqing,YAO Weitao,WANG Jiaqiang,ZHANG Peng,WANG Chuangjian,WANG Xin.. EPIPHYSEAL DISTRACTION FOR PRESERVATION OF EPIPHYSIS OF OSTEOSARCOMA IN CHILDREN. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(11): 1291-1295. doi: Copy

1.	Yoshida Y, Osaka S, Tokuhashi Y. Analysis of limb function after various reconstruction methods according to tumor location following resection of pediatric malignant bone tumors. World J Surg Oncol, 2010, 8: 39.
2.	Gaston CL, Tillman RM, Grimer RJ. Distal femoral physeal growth arrest secondary to a cemented proximal femoral endoprosthetic replacement. J Bone Joint Surg (Br), 2011, 93(5): 708-710.
3.	Rosen G, Caparros B, Huvos AG, et al. Preoperative chemotherapy for osteogenic sarcoma: selection of postoperative adjuvant chemotherapy based on the response of the primary tumor to preoperative chemotherapy. Cancer, 1982, 49(6): 1221-1230.
4.	San-Julian M, Dölz R, Garcia-Barrecheguren E, et al. Limb salvage in bone sarcomas in patients younger than age 10: a 20-year experience. J Pediatr Orthop, 2003, 23(6): 753-762.
5.	Duffaud F, Egerer G, Ferrari S, et al. A phase II trial of second-line pemetrexed in adults with advanced/metastatic osteosarcoma. Eur J Cancer, 2012, 48(4): 564-570.
6.	Cañadell J, Forriol F, Cara JA. Removal of metaphyseal bone tumours with preservation of theepiphysis. Physeal distraction before excision. J Bone Joint Surg (Br), 1994, 76(1): 127-132.
7.	Mavrogenis AF, Mitsiokapa EA, Sakellariou VI, et al. Functional and radiographic outcome after tumor limb salvage surgery using STANMORE megaprostheses. J BUON, 2011, 16(2): 353-360.
8.	Basener CJ, Mehlman CT, DiPasquale TG. Growth disturbance after distal femoral growth plate fractures in children: a meta-analysis. J Orthop Trauma, 2009, 23(9): 663-667.
9.	Yu XC, Xu M, Song RX, et al. Marginal resection for osteosarcoma with effective preoperative chemotherapy. Orthop Surg, 2009, 1(3): 196-202.
10.	Ferrari S, Ruggieri P, Cefalo G, et al. Neoadjuvant chemotherapy with methotrexate, cisplatin, and doxorubicin with or without ifosfamide in nonmetastatic osteosarcoma of the extremity: an Italian sarcoma group trial ISG/OS-1. J Clin Oncol, 2012, 30(17): 2112-2118.
11.	Song SH, Kim SE, Agashe MV, et al. Growth disturbance after lengthening of the lower limb and quantitative assessment of physeal closure in skeletally immature patients with achondroplasia. J Bone Joint Surg (Br), 2012, 94(4): 556-563.
12.	Scott RT, Kissel C, Miller A. Correction of longitudinal epiphyseal bracket disease with external fixation: a case report with 6-year follow-up period. J Foot Ankle Surg, 2011, 50(6): 714-717.
13.	Jesus-Garcia R, Seixas MT, Costa SR, et al. Epiphyseal plate involvement in osteosarcoma. Clin Orthop Relat Res, 2000, (373): 32-38.
14.	Kaste SC. Imaging pediatric bone sarcomas. Radiol Clin North Am, 2011, 49(4): 749-765.
15.	Cho HS, Oh JH, Han I, et al. Joint-preserving limb salvage surgery under navigation guidance. J Surg Oncol, 2009, 100(3): 227-232.
16.	Kiatisevi P, Witoonchart K, Pattarabanjird N, et al. Palliative limb salvage using a retrograde nail-cement composite after intercalary resection of a distal femoral osteosarcoma: a case report. J Orthop Surg (Hong Kong), 2009, 17(3): 383-387.
17.	Yu XC, Xu M, Xu SF, et al. Long-term outcomes of epiphyseal preservation and reconstruction with inactivated bone for distal femoral osteosarcoma of children. Orthop Surg, 2012, 4(1): 21-27.
18.	Sales de Gauzy J, Accadbled F, Gomez Brouchet A, et al. Case report: histologic study of a human epiphyseal transplant at 3 years after implantation. Clin Orthop Relat Res, 2009, 467(7): 1915-1920.
19.	Avila G, Neiva R, Misch CE, et al. Clinical and histologic outcomes after the use of a novel allograft for maxillary sinus augmentation: a case series. Implant Dent, 2010, 19(4): 330-341.
20.	Tsuchiya H, Tomita K, Mori Y, et al. Marginal excision for osteosarcoma with caffeine assisted chemotherapy. Clin Orthop Relat Res, 1999, (358): 27-35.

1. Yoshida Y, Osaka S, Tokuhashi Y. Analysis of limb function after various reconstruction methods according to tumor location following resection of pediatric malignant bone tumors. World J Surg Oncol, 2010, 8: 39.
2. Gaston CL, Tillman RM, Grimer RJ. Distal femoral physeal growth arrest secondary to a cemented proximal femoral endoprosthetic replacement. J Bone Joint Surg (Br), 2011, 93(5): 708-710.
3. Rosen G, Caparros B, Huvos AG, et al. Preoperative chemotherapy for osteogenic sarcoma: selection of postoperative adjuvant chemotherapy based on the response of the primary tumor to preoperative chemotherapy. Cancer, 1982, 49(6): 1221-1230.
4. San-Julian M, Dölz R, Garcia-Barrecheguren E, et al. Limb salvage in bone sarcomas in patients younger than age 10: a 20-year experience. J Pediatr Orthop, 2003, 23(6): 753-762.
5. Duffaud F, Egerer G, Ferrari S, et al. A phase II trial of second-line pemetrexed in adults with advanced/metastatic osteosarcoma. Eur J Cancer, 2012, 48(4): 564-570.
6. Cañadell J, Forriol F, Cara JA. Removal of metaphyseal bone tumours with preservation of theepiphysis. Physeal distraction before excision. J Bone Joint Surg (Br), 1994, 76(1): 127-132.
7. Mavrogenis AF, Mitsiokapa EA, Sakellariou VI, et al. Functional and radiographic outcome after tumor limb salvage surgery using STANMORE megaprostheses. J BUON, 2011, 16(2): 353-360.
8. Basener CJ, Mehlman CT, DiPasquale TG. Growth disturbance after distal femoral growth plate fractures in children: a meta-analysis. J Orthop Trauma, 2009, 23(9): 663-667.
9. Yu XC, Xu M, Song RX, et al. Marginal resection for osteosarcoma with effective preoperative chemotherapy. Orthop Surg, 2009, 1(3): 196-202.
10. Ferrari S, Ruggieri P, Cefalo G, et al. Neoadjuvant chemotherapy with methotrexate, cisplatin, and doxorubicin with or without ifosfamide in nonmetastatic osteosarcoma of the extremity: an Italian sarcoma group trial ISG/OS-1. J Clin Oncol, 2012, 30(17): 2112-2118.
11. Song SH, Kim SE, Agashe MV, et al. Growth disturbance after lengthening of the lower limb and quantitative assessment of physeal closure in skeletally immature patients with achondroplasia. J Bone Joint Surg (Br), 2012, 94(4): 556-563.
12. Scott RT, Kissel C, Miller A. Correction of longitudinal epiphyseal bracket disease with external fixation: a case report with 6-year follow-up period. J Foot Ankle Surg, 2011, 50(6): 714-717.
13. Jesus-Garcia R, Seixas MT, Costa SR, et al. Epiphyseal plate involvement in osteosarcoma. Clin Orthop Relat Res, 2000, (373): 32-38.
14. Kaste SC. Imaging pediatric bone sarcomas. Radiol Clin North Am, 2011, 49(4): 749-765.
15. Cho HS, Oh JH, Han I, et al. Joint-preserving limb salvage surgery under navigation guidance. J Surg Oncol, 2009, 100(3): 227-232.
16. Kiatisevi P, Witoonchart K, Pattarabanjird N, et al. Palliative limb salvage using a retrograde nail-cement composite after intercalary resection of a distal femoral osteosarcoma: a case report. J Orthop Surg (Hong Kong), 2009, 17(3): 383-387.
17. Yu XC, Xu M, Xu SF, et al. Long-term outcomes of epiphyseal preservation and reconstruction with inactivated bone for distal femoral osteosarcoma of children. Orthop Surg, 2012, 4(1): 21-27.
18. Sales de Gauzy J, Accadbled F, Gomez Brouchet A, et al. Case report: histologic study of a human epiphyseal transplant at 3 years after implantation. Clin Orthop Relat Res, 2009, 467(7): 1915-1920.
19. Avila G, Neiva R, Misch CE, et al. Clinical and histologic outcomes after the use of a novel allograft for maxillary sinus augmentation: a case series. Implant Dent, 2010, 19(4): 330-341.
20. Tsuchiya H, Tomita K, Mori Y, et al. Marginal excision for osteosarcoma with caffeine assisted chemotherapy. Clin Orthop Relat Res, 1999, (358): 27-35.

Chinese Journal of Reparative and Reconstructive Surgery

EPIPHYSEAL DISTRACTION FOR PRESERVATION OF EPIPHYSIS OF OSTEOSARCOMA IN CHILDREN

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