This document discusses bone and soft-tissue tumors. It provides information on different types of bone tumors like osteosarcoma, chondrosarcoma, and Ewing's sarcoma. It also discusses approaches to musculoskeletal tumors including history, imaging, biopsy, and differential diagnosis. Surgical treatment options for bone cancers include resection, reconstruction, and prosthesis replacement. Limb salvage is preferred over amputation when possible. Follow-up care after treatment is also covered.

1. Block 7: Musculoskeletal System
Limbsalvage of
Bone and Soft-Tissue Tumors
骨科
簡松雄
Tel:07- 3208209
shchien@kmu.edu.tw
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2. Block 7: Musculoskeletal System Bone and Soft-Tissue Tumors
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3. Block 7: Musculoskeletal System Bone and Soft-Tissue Tumors
Enchondroma
Chondroblastoma
Chondrosarcoma
Osteoblastoma
Osteosarcoma
Fibrosarcoma
Myeloma
Lymphoma
Giant cell tumor
Ewing’s sarcoma
Osteochondroma
Osteoid osteoma
Maligant fibrous Histiocytoma
Age(years)
0 10 20 30 40 50 60 70
FIGURE69-1. Age distribution of patients with bone tumor according to type. (Wilkins. R.M. and
3 Sim. F.H. Evaluation of Bone and Soft Tissue Tumors. In D Ambrosia R.D.(ed): Musculcskeletal
Disorders Philadelphia J. B.Lippincou. 1986

4. Block 7: Musculoskeletal System
Bone and Soft-Tissue Tumors
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5. Block 7: Musculoskeletal System
Clinical Approach to Musculoskeletal Tumors
KMU PRACTICE GUIDELINES
PATIENT COMPLAINT
HISTORY AND PHYSICAL EXAMINATION
SOFT TISSUE CLINICAL INFORMATION BONE
IMAGE STUDY INTERPRETATION IMAGE STUDY
LAB TEST TUMOR TUMOR LAB TEST
SOFT TISSUE TUMOR BONE TUMOR
DIFFFERENTIAL DIAGNOSIS
PROBABLE PROBABLE
BENIGN MALIGNANT BENIGN MALIGNANT METASTASES
BIOPSY
CLINICAL, RADIOGRAPHIC, AND
PATHOLOGIC CORRELATION
DIAGNOSIS
SURGICAL STAGING
5 TREATMENT DESIGN
Bone and Soft-Tissue Tumors

6. Block 7: Musculoskeletal System Bone and Soft-Tissue Tumors
Surgical Margin of Musculoskeletal Tumors
Musculoskeletal Cancer Surgery
6 M.M.Malawer 2001

7. Block 7: Musculoskeletal System
Material and Method-1
Time: 1989---2005
Case: 33 patients, 38 prosthesis ( 5 revision)
Sex: 15 male, 18 female
Age: 15---63 y/o, average: 28 y/o
primary malignant: 22 y/o
metastases: 45 y/o
Tumor: osteosarcoma– 19, malignant lymphoma– 2
malignant GCT-- 3, admantinoma– 1
chondrosarcoma—1, MFH—1
7 soft part sarcoma—1, metastases--5

8. Block 7: Musculoskeletal System
Material and Method-2
Anatomic location: distal femur– 14,
proximal femur– 5
total femur– 1
proximal tibia – 6
proximal humerus– 3
pelvic– 2
diaphysis-- 2 (humerus-1, tibia-1)
Tumor prosthesis: knee joint– 21 (femur-15, tibia-6)
hip joint—8 (saddle-2, THR-3, bipolar-3)
shoulder joint– 3
8 intercalate diaphysis—2(humerus-1, tibia-1)

9. Block 7: Musculoskeletal System
Results-1
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10. Block 7: Musculoskeletal System
Results-2
1. Functional scores of M-S Tumor Society: (motion , pain ,
stability/deformity , strength , functional activities ,
emotional acceptance ) - Excellent=5 , Good=3 , fair=1 ,
Poor=0
average 24 (13---28) ,
80% normal function (30)
2. Complication : aseptic loosen 2 ( revision)
stem broken 1 (revision)
stem migration 1 (observation)
hinge broken 2 (revision)
10 infection 3 ( 1 A-K amputation)

11. Block 7: Musculoskeletal System
Discussion
1. Satisfied functional result
2. Normal soft tissue envelope
3. Longevity of prosthesis
4. Infection rate
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12. Block 7: Musculoskeletal System
Malignant Tumor
Non-Resection Resection
IORT Re-Implantation Bone-Transplantation Prosthesis Only
(60Gray) 1.Autoclave 1.Autograft Replacement
(121-135 oC, a. free 1.Custom
5-15 min) b.vascular
2.Growing Rotation
2.Pasteurization c.lengthen
Plasty
(62 o C, 71 oC, 2.Allograft 3.Spacer
30min) 3.Xenograft 4. lengthen
3.after IORT
Segment
(extracorporeal)
Amputation
4.alcoholization
(95% A/C, 30 min)
5.Liquid N2, 30 min
Utilization Bone of tumor Discarding
Limb salvage Amputation
12 Bone and Soft-Tissue Tumors

13. Block 7: Musculoskeletal System Bone and Soft-Tissue Tumors
Bone Cancers KMU PRACTICE GUIDELINES
EVALUATION TREATMENT FOLLOW-UP RECURRENCE
P’t complain
S/S Diagnosis(special fig.) Follow-up Local
H&P •Osteosarcoma
•Chondrosarcoma -every 3 mo for yr1+2 •Repeat
•Ewing’s Sarcoma primary
Bone lesion -every 4 mo for yr 3
Chest x-ray •Other primary malignant treatment
Lab studies •Carcinoma Metastases -every 6 mo for yr 4+5
MRI + CT
-every 1 yr for yr 6-10
Surgery
Biopsy •En block resection •Physical examination Systemic
• needle •Reconstruction •X-ray of lesion metastases
(CT,Echo) •Wide margins
•open •Limbsalvage if possible •Chest x-ray •Lung only:
•frozen •Amputation •Bone scan resection+C/T
Chemotherapy C/T •Lab test •Other sites:
•Preoperation •Chest CT if abnormal Best
Bone scan
•Single •Postoperation supportive
•Multiple x-ray finding
Radiotherapy R/T Treatment
13Staging •Preoperation
•Postoperation

14. Block 7: Musculoskeletal System
Soft-tissue Sarcomas KMU PRACTICE GUIDELINES
EVALUATION TREATMENT MODALITY FOLLOW-UP RECURRENCE
P’t complain Surgery Low grade, Local:
S/S •En block resection Effective wide
H&P •Wide margins Repeat
Resectable
margin
Soft tissue •Limbsalvage if possible treatment
mass •Amputation Follow-up:
-every 3 mo for yr1+2
Echo -every 4 mo for yr 3
Chest x-ray -every 6 mo for yr 4+5
•High grade -every 1 yr for yr 6-10
Lab studies •Physical examination
•No effective
MRI + CT Resectable •X-ray of lesion
wide margin
•Chest x-ray
•Galium scan
Biopsy •Lab test
•Chest CT if abnormal
• Needle x-ray finding
(CT,Echo) Unresectable
•Open Radiotherapy
•Frozen
•Galium scan Chemotherapy Metastases:
•Doxorubicin •Single organ—debulking tumor,or
•Single
•Ifosfamide metastasectomy ,+R/T ,+C/T
•Multiple •Disseminated---- palliative surgery,
Metastases •TPOG-RMS-95
best supportive treatment
14Staging
Bone and Soft-Tissue Tumors

15. Block 7: Musculoskeletal System Bone and Soft-Tissue Tumors
Summary / take home message
 Oncologic team work for treatment of cancer
patients
 The current trend of surgical method for
malignant tumors is limbsalvage more than
amputation
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16. Block 7: Musculoskeletal System Bone and Soft-Tissue Tumors
THANKS FOR YOUR ATTENTION
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