Childhood Malignant Tumors of Lower Limbs
Conditions
Keywords
Diaphyseal reconstruction techniques, Induced membrane technique, Vascularized fibula, Vascularized fibula grafts, Malignant tumors, Childhood
Brief summary
Primary malignant bone tumors represent 5% of malignant tumors in children, 90% of which are osteosarcomas or Ewing sarcomas. The objective of oncological resection is local control of the disease. Excision of the entire tumor should make it possible to maintain good function of the limb, minimizing morbidity, and promoting acceptance by the patient. Biological reconstructions offer the best long-term functional results. Several possibilities are then available: the Induced Membrane technique, the Vascularized Fibula and Vascularized Fibula associated with an Allograft. Until today, no reconstruction technique in children has proven its superiority over another and no decision-making algorithm for therapeutic care has been determined based on the importance of the bone resection and the affected segment in diaphyseal tumor reconstruction surgery of the lower limb. The aim of the present research is to compare the three techniques concerning the consolidation aspect, the reoperation rates, the rates of bone complications, septic, and the functional results by the study of the medical files of approximately 90 patients operated between 1986 and 2017.
Detailed description
Primary malignant bone tumors represent 5% of malignant tumors in children, 90% of which are osteosarcomas or Ewing sarcomas. The diagnosis of a bone tumor is based on the clinical, radiological and biopsy comparison. The main issue in the treatment of malignant tumors is the vital prognosis and secondarily the functional prognosis. Historically, primary malignant bone tumors have been treated by amputation. The tumor resection, thanks to advances in chemotherapy since the 1970s, today shows survival rates identical to radical techniques. The goal of surgery is local control of the disease. The excision of the entire tumor should make it possible to maintain good function of the limb, in particular to minimize morbidity, and promote acceptance by the patient. Biological reconstructions offer the best long-term functional results. Several possibilities are then available: the Induced Membrane, the Vascularized Fibula and the Vascularized Fibula associated with an Allograft. Until today, no reconstruction technique in children has proven its superiority over another and no decision-making algorithm for therapeutic care has been determined based on the importance of the bone resection and the affected segment in diaphyseal tumor reconstruction surgery of the lower limb. The aim of the study is to compare the 3 diaphyseal reconstruction techniques in the context of malignant tumors in children, and to fill this gap, by providing a decision tree allowing this choice to be made. The comparison concerns the consolidation aspect, the reoperation rates, the rates of bone complications, septic, and the functional results by the study of the medical files of approximately 90 patients operated between 1986 and 2017. The hypothesis of the study is that one of the techniques offers better consolidation rates in major resections, and that adjuvant oncological treatments modify the results that can be expected from these different techniques.
Interventions
OTHERData collection from hospital medical records
Data collection from hospital medical records of patients concerning the 5 years following the resection of the tumor.
Sponsors
URC-CIC Paris Descartes Necker Cochin
Assistance Publique - Hôpitaux de Paris
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
No minimum to 17 Years
Healthy volunteers
No
Inclusion criteria
* Patient under 18 years old with a malignant bone tumor of the lower limb (femur or tibia), diaphyseal or metaphyseal-diaphyseal * Patients operated between 1986 and 2017 for a diaphyseal resection of the tumor with biological reconstruction using either Induced Membrane, Vascularized Fibula and Vascularized Fibula associated with an Allograft * Patient with a minimum follow-up of 5 years
Exclusion criteria
* Patient who died within 5 years or who had a follow-up of less than 5 years following the reconstruction procedure * Patient with joint damage * Patient over 18 years old at the time of surgery * Patient who had an isolated reconstruction of the fibula * Opposition of adult patients/holders of parental authority of minor patients to whom the study information note was sent, to the use of the patient's medical data for the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Duration of bone consolidation period | 5 years | Radiological consolidation times based on follow-up radiographs will be compared to the size of the bone resections in order to establish the healing index. The deadlines for providing support to members will also be collected. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of surgical re-intervention | 5 years | The rates of septic, transfusional and immediate intraoperative complications of each surgery will be compared. The recovery rate for sepsis will also be considered. Neurological and vascular complications will also be compared. The total number of interventions will be counted. |
| Short- and long-term complication rates | 5 years | Bone complications will be noted: fractures, pseudarthrosis, axial deviation and stress fractures will be noted and compared between the techniques. Secondary axial deviation and lower limb length inequalities will also be the subject of a comparative study in long-term follow-up. Other rates of septic or other complications will also be noted. |
| Long-term functional results | 5 years | Long-term functional results will be described: joint range of motion is measured clinically at the hip, knee and ankle and reported in degrees from standardized anatomical positions, a VAS assessment of pain is performed, length inequality is measured radiologically and reported in millimeters on based on the non-operated limb, an MSTS score is performed (Musculoskeletal Tumor Society Rating Scale), an Enneking score is also performed. |
| Relationship between radiotherapy and biological reconstruction result | 5 years | To demonstrate the effect of adjuvant oncological treatments, the type of tumor and adjuvant and neoadjuvant treatment will be taken into account. In particular the presence or absence of post-operative radiotherapy. |
Countries
France
Outcome results
None listed