Is amputation necessary if you have osteosarcoma?

Author: Yu Shengji, Chief Physician, Cancer Hospital, Chinese Academy of Medical Sciences

Reviewer: Ge Yuping, deputy chief physician, Peking Union Medical College Hospital

Many people believe that osteosarcoma requires amputation, fearing that the tumor will metastasize to other parts of the body after the limb is saved. Some parents of children with osteosarcoma even insist on having their children's limbs amputated after they come to the hospital.

In fact, after neoadjuvant chemotherapy for osteosarcoma, the limb salvage rate can reach over 90%.

1. At what age can osteosarcoma patients receive limb-sparing treatment?

There is no age requirement for limb-sparing treatment, whether it is a child or a relatively older adolescent. As long as the tumor growth does not involve blood vessels and nerves, and after systematic chemotherapy, the local recurrence rate after limb-sparing treatment is low and the patient's survival rate is high, limb-sparing treatment can be performed.

Because after limb-sparing treatment, its function is better than wearing a prosthesis after amputation, it is very beneficial to the patient's future quality of life.

Figure 1 Original copyright image, no permission to reprint

Unless it is too late when the patient seeks treatment, and the tumor has involved blood vessels and nerves, or even has obvious metastasis, limb-salvage treatment is not possible.

2. What are the limb-salvage methods for osteosarcoma?

There are many techniques and methods for limb salvage. Currently, the most commonly used and most effective one in clinical practice is joint replacement after local tumor resection.

For example, if the bone tumor at the distal end of the femur shrinks after chemotherapy, surgery can be performed to remove the bone with the tumor, and a prosthesis can be installed after the removal. The distal end of the prosthesis is installed on the tibia, forming a modular tumor joint. After the operation, the patient's limbs can move normally. After treatment, such children can go to school and participate in various sports like normal children.

In addition, for some children, the tumor bone can be removed, and then the bone can be alcohol-inactivated, that is, soaked in alcohol, or frozen in liquid nitrogen, or even irradiated. Through these methods, some tumor cells that may exist in the bone can be inactivated, and then it can be replanted in situ. After replantation in situ, the place is connected with a steel plate or stitches to reconstruct the joint.

Another method is to use allogeneic bone for joint reconstruction, which is to use a piece of bone donated by someone else, a piece of bone of similar size to replace the patient's bone. It is also fixed, and after a period of growth, it can also replace some functions. This is called allogeneic bone joint transplantation.

But no matter what method is used for limb-saving treatment, chemotherapy is usually performed before surgery to ensure the success rate of the surgery.

3. What is the role of chemotherapy before limb-sparing treatment for osteosarcoma?

The most advanced treatment for osteosarcoma is limb-sparing surgery under neoadjuvant chemotherapy.

That is to say, before surgical treatment, almost all patients need to undergo high-dose chemotherapy. After 2-4 cycles of chemotherapy, limb-saving treatment can be performed. The leg can be saved without amputation, so it is called limb-saving technology.

Figure 2 Original copyright image, no permission to reprint

Because when osteosarcoma patients seek medical treatment, about 60%-70% of them have occult metastasis in their bodies. That is, although metastasis has occurred, it cannot be detected in imaging. We call this micro-metastasis submetastatic lesions.

Through chemotherapy, these sub-metastatic lesions can be eliminated and the local tumor can be reduced. After the reduction, surgery can achieve a tumor-free principle and improve the local limb salvage rate and his long-term survival rate.

Of course, after the operation, you will need at least six cycles of chemotherapy. In foreign countries, the chemotherapy time may be relatively longer. Therefore, the total treatment time will take about 1-2 years.

4. How should patients undergoing limb-sparing surgery for osteosarcoma be followed up and reviewed?

Inspection frequency:

Generally, follow-up is done every three months within two years; every six months from the third to the fifth year; and every two years from the sixth to the tenth year. Generally speaking, if there is no local recurrence or distant metastasis within ten years, 90% of the patients can be cured.

Check items:

First, an X-ray should be taken to see the part where the tumor was removed. If conditions permit, a CT scan or MRI can be done to see if there are any abnormalities in the local area. Whether it is a joint replacement or a bone transplant, it is very important to see if the joint is loose and whether there is any local recurrence.

As for distant situations, since the organ to which osteosarcoma is most likely to metastasize is the lung, chest X-ray or chest CT can detect some metastatic lesions early, which is also very important.

Hospitals with the necessary conditions may also perform whole-body bone scans to see if there are any lesions in other bones.

Some patients also need to undergo routine blood tests, such as blood routine tests, blood biochemistry, etc.