Methods of Biological Reconstruction for Bone Sarcoma: Indications and Limits
Therapy of bone sarcoma has dramatically changed over the past few decades. Several successful interdisciplinary treatment strategies have led to an increase of the survival rates from 20% to 60%–80%. Consequently new demands on the operative treatment of
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Pierre Kunz and Ludger Bernd
Abstract Therapy of bone sarcoma has dramatically changed over the past few decades. Several successful interdisciplinary treatment strategies have led to an increase of the survival rates from 20% to 60%–80%. Consequently new demands on the operative treatment of bone and soft tissue sarcoma have arisen. Nowadays limb salvage can be achieved in 80%–90% using tumour megaprostheses or biological reconstruction procedures. In this article we outline the indications and limitations of biological reconstruction procedures after bone tumour resection. We therefore introduce the different biological approaches such as free autologous bone grafting, reimplantation of extracorporeal devitalized autografts or distraction osteogenesis and summarize the currently available data on the individual procedures. Our analyses demonstrate a wide applicability of biological procedures in tumour situations. Although accompanied by considerable complications in the early postoperative phase,
Pierre Kunz (*) Stiftung Orthopädische Universitätsklinik Heidelberg Schlierbacher Landstrasse 200a 69118 Heidelberg, Germany E-mail: [email protected]
biological reconstructions clearly demonstrate the potential of having excellent long-term durability and functionality.
9.1 Introduction Bone sarcomas represent approximately 10% of all malignancies in growing patients and 1% of malignancies in adults. Therapy of these rare sarcomas has changed considerably; within the past few decades several successful interdisciplinary treatment strategies have been established [15, 70]. The introduction and improvement of adjuvant chemo- and radiotherapy in bone and soft tissue sarcoma has led to an increase of the survival rates from 20% to 60%–80% [4, 74, 95]. Consequently, additional demands are being placed on the operative treatment of bone and soft tissue sarcoma: Whereas formerly the most important therapeutic consideration was the amputation height of the affected extremity, standards for surgical procedures of bone sarcomas are considerably higher today. Without affecting the (still necessary) radicality of tumour resection for oncological reasons, a long-lasting stability and durability as well as a maximum degree of
Per-Ulf Tunn (Ed.), Treatment of Bone and Soft Tissue Sarcomas. Recent Results in Cancer Research 179, DOI: 10.1007/978-3-540-77960-5, © Springer-Verlag Berlin Heidelberg 2009
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functionality, analgesia and emotional acceptance is expected by the reconstruction procedures. Thanks to improvements in local and systemic tumour control through chemotherapy, a more precise radiological description of the tumour situation, and a better understanding of tumour biology and staging, as well as an improvement of microsurgical techniques, the new demands can often be accommodated. Thus a variety of limb salvage surgical procedures have been advanced and implemented in different oncological centres throughout the world in the last 30 years. These procedures nowadays enable the experienc
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