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Extremity sarcoma surgery in younger children: ten years of patients ten years and under
Ryan B Israelsen1, Benjamin E Illum, Susie Crabtree
1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, USA.
Insights
Pediatric sarcoma surgery in children under ten presents unique challenges due to growth concerns. Despite these complexities, surgical treatment for pediatric sarcomas generally leads to favorable long-term outcomes.
Area of Science:
- Pediatric Orthopedic Oncology
- Skeletal Sarcoma Surgery
- Pediatric Cancer Treatment
Background:
- Sarcoma surgery in skeletally immature patients poses distinct challenges.
- Concerns about radiation and bone growth impact treatment decisions for pediatric sarcomas.
- Limited literature exists specifically addressing sarcoma surgery in young children.
Purpose of the Study:
- To review surgical management and outcomes of limb and limb-girdle sarcomas in patients aged ten years or younger.
- To identify challenges and successes in treating pediatric sarcomas in a tertiary care setting.
Main Methods:
- Retrospective review of medical records from a regional sarcoma treatment program.
- Inclusion criteria: patients aged ten years or younger at the time of initial surgery for limb/limb-girdle sarcomas.
- Data collected: demographics, diagnosis, surgical procedures, complications, and outcomes.
Main Results:
- 43 patients were identified, with common diagnoses including osteosarcoma and Ewing's sarcoma family tumors.
- Tumor location showed a higher predilection for the upper extremity compared to adolescents.
- Overall survival was favorable, with five disease-related deaths; 16 patients required further surgeries.
Conclusions:
- Sarcoma surgery in young children presents significant surgical, patient, and parental challenges.
- Despite challenges, surgical intervention for pediatric sarcomas typically results in successful long-term functional outcomes.
- Further research into optimizing surgical strategies for this age group is warranted.
Abstract:
Sarcoma surgeons face unique challenges in younger patients with significant skeletal growth remaining. The heightened concerns regarding radiation in the very young and the drastic changes expected in the lengths and cross-sectional areas of bones affect the decision-making for both soft-tissue and bone sarcomas in this population. Nonetheless, there is sparse literature focused on sarcoma surgery in this age group. The records of one tertiary regional sarcoma treatment program were reviewed to identify all patients ten years old or younger at the time of local control surgery for limb or limb-girdle sarcomas. Demographic information, diagnosis, surgery performed, complications, and general outcomes were gleaned from the medical records. 43 patients were identified, including 15 with osteosarcomas, 11 Ewing's sarcoma family tumors, five rhabdomyosarcomas, and two synovial sarcomas, among others. Location of tumors varied widely, but demonstrated a predilection for the upper extremity more than is typical in adolescents with the same tumor types. Survival was favorable overall, with only five patients dying from disease. Most patients continued to function well at latest follow-up, but 16 experienced additional surgical interventions following the index procedure. Sarcoma surgery in the younger growing child presents challenges for the surgeon, patient, and parents, but is usually successful in the long-term.
