engleski

Bone tumors in children: incidence, diagnosis, surgical treatment and complications

Bone tumor treatment changed considerably during past decades. Due to improvements in basic research in the areas of tumor biology, tumor detection and imaging, surgical procedures and development of modern surgical instruments, discovery and use of new technical equipment, and especially in the use of chemotherapy and radiotherapy, significant progress has been achieved. About 100 new patients with primary bone tumor (both benign and malignant) are discovered in Croatia and treated at the Department of Orthopaedic Surgery, Clinical Hospital Centre Zagreb and Zagreb University School of Medicine per year, and almost a half of them (45%) are younger than 20 years. The most common benign bone tumors are osteochondroma, simple (juvenile) bone cyst, and osteoid osteoma, and the most common malignant bone tumors are osteosarcoma and Ewing sarcoma. Bone tumors are localized mostly in a long bones (femur, tibia, humerus), and the knee joint region is the most common site of tumors. Patient history and examination with laboratory and imaging methods remain the essence in tumor diagnosis. A conventional X- ray examination must be the first and the most important part in tumor imaging, followed by bone scan, CT, MRI, ultrasound, and histological or cytological analysis. The biopsy, as the most accurate method in tumor diagnosis must be performed as the last diagnostic procedure. Cytological analysis is useful in tumors with soft tissue. An individual approach to patient is essential in order to choose the most suitable surgical treatment for bone tumor. Depending on the tumor type, location and other patient related risk-factors, one of the various forms of surgical therapy should be chosen. Limb salvage surgery means “ en-bloc” tumor resection with affected part of the bone through a healthy tissue and defect reconstruction, with preservation of the affected limb ; this procedure is performed nowadays in about 85% of patients with malignant bone tumors. Reconstruction can be biologic (with bone auto- or homotransplant) or with foreign material (i.e. endoprosthesis or bone cement). Soft tissue reconstruction is a great challenge in this part of a treatment, and complications are not rare. Amputation still has and will have in the future an important place in treating patients with malignant bone tumor. Decision of additional chemo- and/or radiotherapy pediatric, oncologist and orthopaedic surgeon should make together, according to international guidelines. Future devolvement in treating patients with bone tumors point into supporting and/or establishing reparative procedures. Bone and surrounding tissue regeneration is always better than defect reconstruction.

bone tumors ; paediatric orthopaedics ; limb salvage surgery ; endoprosthesis

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