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Zhao G, Guan L, Zhang Y, Shi X, Luo W, Yang M, Wang Q, Liu Z, Liu Y, Ding X, Zhao J. 18F-AlF-NOTA-octreotide PET/CT and 3D printing technology for precision diagnosis and treatment of phosphaturic mesenchymal tumors in patients with tumor-induced osteomalacia: two case reports. Front Endocrinol (Lausanne) 2024; 15:1359975. [PMID: 39634185 PMCID: PMC11614613 DOI: 10.3389/fendo.2024.1359975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 10/31/2024] [Indexed: 12/07/2024] Open
Abstract
Objective This study aims to report the application of 18F-AlF-NOTA-Octreotide PET/CT and 3D printing technology in the diagnosis and treatment of phosphaturic mesenchymal tumors (PMT) in patients with tumor-induced osteomalacia (TIO). Case presentation A 68-year-old male patient (Case 1) was admitted to the Weifang People's Hospital in August 2022 with complaints of "persistent pain in the bilateral flank and lumbosacral region". 18F-AlF-NOTA-Octreotide PET/CT showed high octreotide expression in the left femoral region. A 48-year-old male patient (Case 2) was admitted to the Weifang People's Hospital in November 2022, complaining of "pain in the lumbar region and ribs". 18F-AlF-NOTA-Octreotide PET/CT showed high octreotide expression in the pancreatic uncinate process and the left acetabulum. They were diagnosed with hypophosphatemic osteomalacia, with a strong consideration of an underlying neuroendocrine tumor. Preoperative design of 3D virtual surgery, CAD/CAM, and 3D printing technology were used to customize the digital surgical guide plates, and the surgery was carried out. They were both finally confirmed as phosphateuric mesenchymal tumors (PMT) based on postoperative pathology and immunohistochemistry results. Both patients experienced substantial relief from their clinical manifestations after surgery. Conclusion 18F-AlF-NOTA-Octreotide PET/CT may be a precise diagnostic method for TIO, while 3D printing technology may serve as an effective and dependable adjunct for the treatment of PMT in patients with TIO.
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Affiliation(s)
- Gang Zhao
- Department of Orthopedics and Trauma, Weifang People’s Hospital, First Affiliated Hospital of Shandong Second Medical University, Weifang, China
| | - Lijuan Guan
- Nursing Department, Weifang Stomatology Hospital, Weifang, China
| | - Yongqiang Zhang
- Department of Orthopedics and Trauma, Weifang People’s Hospital, First Affiliated Hospital of Shandong Second Medical University, Weifang, China
| | - Xingzhen Shi
- Department of Orthopedics and Trauma, Weifang People’s Hospital, First Affiliated Hospital of Shandong Second Medical University, Weifang, China
| | - Wenming Luo
- Department of Orthopedics and Trauma, Weifang People’s Hospital, First Affiliated Hospital of Shandong Second Medical University, Weifang, China
| | - Maiqing Yang
- Department of Pathology, Weifang People’s Hospital, First Affiliated Hospital of Shandong Second Medical University, Weifang, China
| | - Qi Wang
- Department of Orthopedics and Trauma, Weifang People’s Hospital, First Affiliated Hospital of Shandong Second Medical University, Weifang, China
| | - Zhen Liu
- Department of Orthopedics and Trauma, Weifang People’s Hospital, First Affiliated Hospital of Shandong Second Medical University, Weifang, China
| | - Yongqiang Liu
- Department of Orthopedics and Trauma, Weifang People’s Hospital, First Affiliated Hospital of Shandong Second Medical University, Weifang, China
| | - Xiaolei Ding
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Jie Zhao
- Department of Orthopedics and Trauma, Weifang People’s Hospital, First Affiliated Hospital of Shandong Second Medical University, Weifang, China
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Bruschi A, Donati DM, Di Bella C. What to choose in bone tumour resections? Patient specific instrumentation versus surgical navigation: a systematic review. J Bone Oncol 2023; 42:100503. [PMID: 37771750 PMCID: PMC10522906 DOI: 10.1016/j.jbo.2023.100503] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
Patient specific instrumentation (PSI) and intraoperative surgical navigation (SN) can significantly help in achieving wide oncological margins while sparing bone stock in bone tumour resections. This is a systematic review aimed to compare the two techniques on oncological and functional results, preoperative time for surgical planning, surgical intraoperative time, intraoperative technical complications and learning curve. The protocol was registered in PROSPERO database (CRD42023422065). 1613 papers were identified and 81 matched criteria for PRISMA inclusion and eligibility. PSI and SN showed similar results in margins (0-19% positive margins rate), bone cut accuracy (0.3-4 mm of error from the planned), local recurrence and functional reconstruction scores (MSTS 81-97%) for both long bones and pelvis, achieving better results compared to free hand resections. A planned bone margin from tumour of at least 5 mm was safe for bone resections, but soft tissue margin couldn't be planned when the tumour invaded soft tissues. Moreover, long osteotomies, homogenous bone topology and restricted working spaces reduced accuracy of both techniques, but SN can provide a second check. In urgent cases, SN is more indicated to avoid PSI planning and production time (2-4 weeks), while PSI has the advantage of less intraoperative using time (1-5 min vs 15-65 min). Finally, they deemed similar technical intraoperative complications rate and demanding learning curve. Overall, both techniques present advantages and drawbacks. They must be considered for the optimal choice based on the specific case. In the future, robotic-assisted resections and augmented reality might solve the downsides of PSI and SN becoming the main actors of bone tumour surgery.
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Affiliation(s)
- Alessandro Bruschi
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
- Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
| | - Davide Maria Donati
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy
| | - Claudia Di Bella
- Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
- Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
- VBJS, Victorian Bone and Joint Specialists, 7/55 Victoria Parade, Fitzroy, VIC 3065, Australia
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Henderson ER, Hebert KA, Werth PM, Streeter SS, Rosenthal EL, Paulsen KD, Pogue BW, Samkoe KS. Fluorescence guidance improves the accuracy of radiological imaging-guided surgical navigation. J Surg Oncol 2023; 127:490-500. [PMID: 36285723 PMCID: PMC10176708 DOI: 10.1002/jso.27128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/08/2022] [Accepted: 09/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Imaging-based navigation technologies require static referencing between the target anatomy and the optical sensors. Imaging-based navigation is therefore well suited to operations involving bony anatomy; however, these technologies have not translated to soft-tissue surgery. We sought to determine if fluorescence imaging complement conventional, radiological imaging-based navigation to guide the dissection of soft-tissue phantom tumors. METHODS Using a human tissue-simulating model, we created tumor phantoms with physiologically accurate optical density and contrast concentrations. Phantoms were dissected using all possible combinations of computed tomography (CT), magnetic resonance, and fluorescence imaging; controls were included. The data were margin accuracy, margin status, tumor spatial alignment, and dissection duration. RESULTS Margin accuracy was higher for combined navigation modalities compared to individual navigation modalities, and accuracy was highest with combined CT and fluorescence navigation (p = 0.045). Margin status improved with combined CT and fluorescence imaging. CONCLUSIONS At present, imaging-based navigation has limited application in guiding soft-tissue tumor operations due to its inability to compensate for positional changes during surgery. This study indicates that fluorescence guidance enhances the accuracy of imaging-based navigation and may be best viewed as a synergistic technology, rather than a competing one.
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Affiliation(s)
- Eric R. Henderson
- Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
- Department of Orthopaedics, Dartmouth Health, Lebanon, New Hampshire, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, New Hampshire, USA
| | - Kendra A. Hebert
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Paul M. Werth
- Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Department of Orthopaedics, Dartmouth Health, Lebanon, New Hampshire, USA
| | - Samuel S. Streeter
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Eben L. Rosenthal
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Keith D. Paulsen
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, New Hampshire, USA
| | - Brian W. Pogue
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kimberley S. Samkoe
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
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Virtual surgical planning and 3D printing in pediatric musculoskeletal oncological resections: a proof-of-concept description. Int J Comput Assist Radiol Surg 2023; 18:95-104. [PMID: 36152167 DOI: 10.1007/s11548-022-02745-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/01/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Patient-specific models may have a role in planning and executing complex surgical procedures. However, creating patient-specific models with virtual surgical planning (VSP) has many steps, from initial imaging to finally realizing the three-dimensional printed model (3DPM). This manuscript evaluated the feasibility and potential benefits of multimodal imaging and geometric VSP and 3DPM in pediatric orthopedic tumor resection and reconstruction. MATERIALS AND METHODS Twelve children with Ewing's sarcoma, osteosarcoma, or chondrosarcoma were studied. Computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) were acquired as the standard-of-care. Bony and soft tissue components of the tumor and the adjacent bone were segmented to create a computer-generated 3D model of the region. VSP used the computer-generated 3D model. The Objet350 Stratasys™ polyjet printer printed the final physical model used for pre-surgical planning, intraoperative reference, and patient education. Clinical impact, the utility of the model, and its geometric accuracy were assessed. RESULTS Subjectively, using the patient-specific model assisted in preoperative planning and intra-operative execution of the surgical plan. The mean difference between the models and the surgical resection was -0.09 mm (range: -0.29-0.45 mm). Pearson's correlation coefficient (r) of the cross-sectional area was -0.9994, linear regression r2 = 0.9989, and the Bland Altman plot at 95% confidence interval showed all data within boundaries. CONCLUSION We studied the geometric accuracy, utility and clinical impact of VSP and 3DPM produced from multi-modal imaging studies and concluded 3DPM accurately represented the patients' tumor and proved very useful to the surgeon in both the preoperative surgical planning, patient and family education and operative phases. Future studies will be planned to evaluate surgery procedure duration and other outcomes.
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Zhang Y, Hai Y, Yang J, Yin P, Han C, Liu J, Zhou L. The feasibility and efficacy of computer-assisted screw inserting planning in the surgical treatment for severe spinal deformity: a prospective study. BMC Surg 2022; 22:265. [PMID: 35810287 PMCID: PMC9270732 DOI: 10.1186/s12893-022-01711-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background The objective of the study was to explore the feasibility and efficacy of computer-assisted screw inserting planning (CASIP) in the surgical treatment for severe spinal deformity. Methods A total of 50 patients participated in this prospective cohort study. 25 patients were allocated into CASIP group and 25 patients were in Non-CASIP group. The demographic data, radiological spinal parameters were documented and analyzed. Each pedicle screw insertion was classified as satisfactory insertion or unsatisfactory insertion based on Gertzbein-Robbins classification. The primary outcome was the accuracy of pedicle screw placement. The secondary outcomes were the rate of puncturing screws, estimated blood loss, surgical time, correction rate and other radiological parameters. Results A total of 45 eligible patients completed the study. 20 patients were in CASIP group and 25 patients were in Non- CASIP group. The accuracy of pedicle screw placement in CASIP Group and Non-CASIP Group were (92.0 ± 5.5) % and (82.6 ± 8.3) % (P < 0.05), and the rate of puncturing screws were (0 (0–0)) % and (0 (0-6.25)) % (P < 0.05). The median surgical time were 280.0 (IQR: 260.0–300.0) min and 310 (IQR: 267.5–390.0) min in two group and showed significant statistic difference (P < 0.05). Conclusions CASIP has good feasibility and can gain a more accurate and reliable instruments fixation, with which spine surgeons can make a detailed and personalized screw planning preoperatively to achieve satisfying screw placement.
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Affiliation(s)
- Yiqi Zhang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, 100020, Beijing, China
| | - Yong Hai
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, 100020, Beijing, China.
| | - Jincai Yang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, 100020, Beijing, China
| | - Peng Yin
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, 100020, Beijing, China
| | - Chaofan Han
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, 100020, Beijing, China
| | - Jingwei Liu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, 100020, Beijing, China.,Department of Orthopedics, Beijing Hospital, Peking University, DongDanDaHuaLu 1#, Dongcheng District, 100005, Beijing, China
| | - Lijin Zhou
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, 100020, Beijing, China.
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Du X, Wei H, Zhang B, Gao S, Li Z, Cheng Y, Fan Y, Zhou X, Yao W. Experience in utilizing a novel 3D digital model with CT and MRI fusion data in sarcoma evaluation and surgical planning. J Surg Oncol 2022; 126:1067-1073. [PMID: 35779067 DOI: 10.1002/jso.26999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/31/2022] [Accepted: 06/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess sarcoma margins with more accuracy and aid surgical planning, we constructed three-dimensional (3D) digital models with computed tomography(CT) and magnetic resonance imaging (MRI) image fusion data and validated the preciseness of the models by comparing them with 3D models constructed with CT only data. MATERIALS AND METHODS We retrospectively reviewed a consecutive set of patients treated in our center who were preoperatively evaluated with the fusion image model. Models based on fusion images or CT-only data were constructed. Volumes of both tumors were calculated and the tumors were overlapped to see the location of differences between the two models. RESULTS A consecutive 12 cases (4 male vs. 8 female) were included in this study. Most of the tumors were located in the pelvic bone or spine. The volume of the two tumor models was different and the differences were mainly in the peripheral region of the tumor. CONCLUSION CT and MRI fusion image 3D models are more accurate than models with CT-only data and can be very helpful in preoperative planning of sarcoma patients.
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Affiliation(s)
- Xinhui Du
- Bone and Soft Tissue Department, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.,Key Laboratory for Digital Assessment of Spinal-Pelvic Tumor and Surgical Aid Tools Design (Zhengzhou), Zhengzhou, Henan, China.,Key Laboratory for Perioperative Digital Assessment of Bone Tumors (Henan), Zhengzhou, Henan, China
| | - Hua Wei
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Boya Zhang
- Bone and Soft Tissue Department, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.,Key Laboratory for Digital Assessment of Spinal-Pelvic Tumor and Surgical Aid Tools Design (Zhengzhou), Zhengzhou, Henan, China.,Key Laboratory for Perioperative Digital Assessment of Bone Tumors (Henan), Zhengzhou, Henan, China
| | - Shilei Gao
- Bone and Soft Tissue Department, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.,Key Laboratory for Digital Assessment of Spinal-Pelvic Tumor and Surgical Aid Tools Design (Zhengzhou), Zhengzhou, Henan, China.,Key Laboratory for Perioperative Digital Assessment of Bone Tumors (Henan), Zhengzhou, Henan, China
| | - Zhehuang Li
- Bone and Soft Tissue Department, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.,Key Laboratory for Digital Assessment of Spinal-Pelvic Tumor and Surgical Aid Tools Design (Zhengzhou), Zhengzhou, Henan, China.,Key Laboratory for Perioperative Digital Assessment of Bone Tumors (Henan), Zhengzhou, Henan, China
| | - Yu Cheng
- Bone and Soft Tissue Department, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Yichao Fan
- Bone and Soft Tissue Department, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.,Key Laboratory for Digital Assessment of Spinal-Pelvic Tumor and Surgical Aid Tools Design (Zhengzhou), Zhengzhou, Henan, China.,Key Laboratory for Perioperative Digital Assessment of Bone Tumors (Henan), Zhengzhou, Henan, China
| | - Xiaotian Zhou
- Bone and Soft Tissue Department, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Weitao Yao
- Bone and Soft Tissue Department, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.,Key Laboratory for Digital Assessment of Spinal-Pelvic Tumor and Surgical Aid Tools Design (Zhengzhou), Zhengzhou, Henan, China.,Key Laboratory for Perioperative Digital Assessment of Bone Tumors (Henan), Zhengzhou, Henan, China
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Christ AB, Hansen DG, Healey JH, Fabbri N. Computer-Assisted Surgical Navigation for Primary and Metastatic Bone Malignancy of the Pelvis: Current Evidence and Future Directions. HSS J 2021; 17:344-350. [PMID: 34539276 PMCID: PMC8436340 DOI: 10.1177/15563316211028137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022]
Abstract
Computer-assisted navigation and robotic surgery have gained popularity in the treatment of pelvic bone malignancies, given the complexity of the bony pelvis, the proximity of numerous vital structures, and the historical challenges of pelvic bone tumor surgery. Initial interest was on enhancing the accuracy in sarcoma resection by improving the quality of surgical margins and decreasing the incidence of local recurrences. Several studies have shown an association between intraoperative navigation and increased incidence of negative margin bone resection, but long-term outcomes of navigation in pelvic bone tumor resection have yet to be established. Historically, mechanical stabilization of pelvic bone metastases has been limited to Harrington-type total hip arthroplasty for disabling periacetabular disease, but more recently, computer-assisted surgery has been employed for minimally invasive percutaneous fixation and stabilization; although still in its incipient stages, this procedure is potentially appealing for treating patients with bone metastases to the pelvis. The authors review the literature on navigation for the treatment of primary and metastatic tumors of the pelvic bone and discuss the best practices and limitations of these techniques.
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Affiliation(s)
- Alexander B. Christ
- Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, CA USA
| | - Derek G. Hansen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - John H. Healey
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicola Fabbri
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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van der Heijden L, Farfalli GL, Balacó I, Alves C, Salom M, Lamo-Espinosa JM, San-Julián M, van de Sande MA. Biology and technology in the surgical treatment of malignant bone tumours in children and adolescents, with a special note on the very young. J Child Orthop 2021; 15:322-330. [PMID: 34476021 PMCID: PMC8381388 DOI: 10.1302/1863-2548.15.210095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/02/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The main challenge in reconstruction after malignant bone tumour resection in young children remains how and when growth-plates can be preserved and which options remain if impossible. METHODS We describe different strategies to assure best possible long-term function for young children undergoing resection of malignant bone tumours. RESULTS Different resources are available to treat children with malignant bones tumours: a) preoperative planning simulates scenarios for tumour resection and limb reconstruction, facilitating decision-making for surgical and reconstructive techniques in individual patients; b) allograft reconstruction offers bone-stock preservation for future needs. Most allografts are intact at long-term follow-up, but limb-length inequalities and corrective/revision surgery are common in young patients; c) free vascularized fibula can be used as stand-alone reconstruction, vascularized augmentation of structural allograft or devitalized autograft. Longitudinal growth and joint remodelling potential can be preserved, if transferred with vascularized proximal physis; d) epiphysiolysis before resection with continuous physeal distraction provides safe resection margins and maintains growth-plate and epiphysis; e) 3D printing may facilitate joint salvage by reconstruction with patient-specific instruments. Very short stems can be created for fixation in (epi-)metaphysis, preserving native joints; f) growing endoprosthesis can provide for remaining growth after resection of epi-metaphyseal tumours. At ten-year follow-up, limb survival was 89%, but multiple surgeries are often required; g) rotationplasty and amputation should be considered if limb salvage is impossible and/or would result in decreased function and quality of life. CONCLUSION Several biological and technological reconstruction options must be merged and used to yield best outcomes when treating young children with malignant bone tumours. LEVEL OF EVIDENCE Level V Expert opinion.
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Affiliation(s)
- Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, the Netherlands,Correspondence should be sent to Lizz van der Heijden MD PhD, Department of Orthopaedic Surgery, Leiden University Medical Centre, Postal Zone J11-R70, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail:
| | - Germán L. Farfalli
- Department of Orthopedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Inês Balacó
- Department of Pediatric Orthopedics – Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cristina Alves
- Department of Pediatric Orthopedics – Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Marta Salom
- Department of Pediatric Orthopedics, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Mikel San-Julián
- Department of Orthopedic Surgery, Clinica Universidad de Navarra, Pamplona, Spain
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