Bone sarcoma resection

Some bone sarcomas, such as osteosarcoma and Ewing sarcoma, usually start with chemotherapy (neoadjuvant), whereas others — such as conventional chondrosarcoma — respond poorly to chemotherapy and radiotherapy and are treated mainly with surgery. Ewing sarcoma is also sensitive to radiotherapy, which can be used when a resection with adequate margins is not possible. The case is studied with imaging — including an MRI of the whole affected bone — and biopsy; staging includes a chest CT and a whole-skeleton study (bone scan, PET-CT or whole-body MRI, depending on the case), and it is decided at a multidisciplinary board.

The tumor is removed with a margin of healthy bone and tissue, taking out the prior biopsy tract en bloc together with the tumor. When the resection spares the neighboring joint, it is preserved; when it includes the joint, it must be replaced.

The defect is then reconstructed. The main options are a megaprosthesis, a bank allograft and, in intercalary defects and in the humerus and forearm, the patient's own vascularized fibula —a graft that comes with its own blood supply, so it unites and remodels as living bone, and can be combined with an allograft—. The choice depends on the location, age and features of the case: a megaprosthesis allows earlier weight-bearing and movement, while biological reconstructions are slower but can be very durable if they unite. In growing children and adolescents there are expandable prostheses.

The goal is to preserve the limb with good function whenever it is oncologically safe; when it is not, limb preservation gives way to the safest option.

Rehabilitation is prolonged and coordinated with the rest of the oncologic treatment, which often continues after surgery. Follow-up is maintained with imaging of the operated area and of the chest to detect a recurrence or metastasis early.

The decision to operate is made together: we discuss the diagnosis, the goals of treatment, the expected benefits, the risks and the alternatives. Surgery does not guarantee an outcome; it aims to control the tumor while preserving as much function as possible.