Unfortunately, the data now are about the same as the data 20 years ago, but the bottom line is that prognostically patients with bone sarcomas with sustained pathologic fractures have a worse overall survival and worse disease-free survival compared with those who do not sustain fracture. In this I mentioned, we monthly journal club we thought it would be an interesting topic to review recent literature on and see if there's been any new findings. There have been a variety of studies over the years. Perhaps we should even try to do limb salvage in these pathologic fractures. Therefore, shouldn't be doing these surgeries. We learned early on that doing ablative surgery or amputations on these kids didn't necessarily do them any much better than if we didn't do ablative surgery on them-meaning they usually died of systemic relapse at a predictable rate. The question also becomes: how do these patients do ontologically, not just in terms of their local control, but how they do systemically or from their oncologic status? You have this contaminated area, and then it's much harder to do limb salvage surgery. When you have this tumor through a pathologic fracture, it spills into the whole compartment and beyond contaminates neurovascular structures. The tumor is usually contained in the egg, but if you break the egg and the poisonous yolk, and egg white gets out all over the place, you have a problem and it's harder to clean up.
#PATHOLOGICAL FRACTURE CANCER CRACKED#
Historically, when someone has fractured through a primary bone sarcoma, it has been a relative indication to do ablative surgery, because you can imagine that the fracture is like a cracked egg.
However, it turned out that this fracture was caused by osteosarcoma. A very well-intended orthopedic surgeon did an open reduction, internal fixation and fixed the fracture. Randall: On our sarcoma service at UC Davis, we recently took care of a, who unfortunately, sustained the pathologic fracture of their femur to what they thought was a bone cyst. OncLive ®: What is the impact of pathologic fractures on the outcome or prognosis of patients, particularly pediatric patients, with bone sarcomas? In an interview with OncLive ®, Randall, who is the David Linn Endowed Chair for Orthopaedic Surgery and professor and chair of the Department of Orthopaedic Surgery, University of California Davis Health, discussed how pathologic fractures can determine outcomes for these patients and the potential for limb salvage therapy.
Their prognosis is worse, but they need systemic therapy, they need to be seen by an orthopedic oncologist who can at least do up-front provisional fixation of the fracture, and there still may be a role for limb salvage surgery.”Įxisting literature have demonstrated how pathologic fractures impact prognosis in patient with osteosarcoma and Ewing sarcoma. “They absolutely must get aggressive chemotherapy still. “For medical oncologists, what they need to know is if they are managing a patient with a bone sarcoma, there is still a role for limb salvage surgery,” Randall said. For patients with osteosarcoma or Ewing sarcoma who develop pathologic fractures, the prognosis remains poor however, there is still the possibility for limb salvage therapy, R.
0 kommentar(er)
