Microwave ablation for osteosarcoma in the long bones of the lower extremity:15 cases report
CHEN Bing-yao
WEI Xing
LI Nan
MA Yun-qing
ZHANG Zeng-liang
SONG Guang-ze
WANG Shuo
Abstract：Objective To investigate the curative effects and complications of microwave ablation in the treatment of conventional osteosarcoma in the femur and tibia. Methods From September 2006 to June 2010, 15 patients were adopted, including 9 males and 6 females with a median age of 16 years old ( range;5-52 years ). The locational distribution was stated as following. There were 6 cases in the distal femur, 5 cases in the femoral diaphysis and the other 4 cases in the proximal tibia. All the patients were classiifed as stage II B according to the Enneking staging system. After the diagnosis was confirmed by biopsy in all the patients, the combined chemotherapy was performed for 1 cycle before the surgery. The tumors were exposed according to the principle of wide resection of malignant tumors. The matrix microwave ablation with several antennas was performed on the tumor-bearing bone. The necrotic tumor tissues were removed after the ablation. The autogeneic or allogeneic ifbular grafting and plate ifxation were performed in 5 cases. The bone cementation and plate ifxation were performed in 3 cases. The autogeneic or allogeneic fibular grafting and plate fixation combined with bone cementation were performed in 2 cases. The simple plate fixation was performed in 3 cases. The simple intramedullary nail fixation was performed in 2 cases. Postoperatively the adjuvant chemotherapy was performed for 4 cycles after the preoperative chemotherapy. During the follow-up, the patients were reexamined at each 3 months during the first 2 years, and later at each 6 months. From the 5th year after the operation, reexamination was performed once 1 year until December 2013. Results All the patients were followed up for 51±20 months. Postoperatively 4 patients had recurrence and lung metastases with the mean recurrence time of 10.2 months and 1 patient had simple lung metastases, who all died. The other 10 patients remained cancer-free. The recurrence rate was 26.7%. The recurrence occurred in the bone in 3 cases, and in the soft tissues in 1 case. The rate of lung metastases was 33.3%. The 2-year and 5-year overall survival rates were 73%and 53%respectively. Pathological fractures and breakage of internal ifxation occurred in 6 cases, and the fracture rate was 40%. The lfexion and extension functions of the knee joints were evaluated at 6 months after the operation, which were close to normal. While in the long-term follow-up, the limb functions of the patients with pathological fractures were obviously aggravated. The scores of the patients with pathological fractures were obviously lower than that of the patients without fractures at 3 years after the operation, and the differences were statistically signiifcant ( P<0.01 ). Conclusions Because there are limited cases in this study, it is hard to draw a deifnite conclusion. However, there are some beneifcial prompts. For the patients with osteosarcoma in the long bones of the lower extremity, the overall survival rate of microwave ablation is comparable to that of other treatment methods in our country. While the technique should be further improved to make sure that the tumors are completely inactivated, so as to reduce the local recurrence. In addition, a long period is needed in the inactivation and recovery process and a high risk of pathological fractures exists after the bone grafting and internal ifxation, so a ifrmer reconstruction method should be adopted. In the treatment of osteosarcoma in the joints of the lower extremity, the tumor wide resection and artiifcial joint replacement maybe an ideal choice.
Keywords：OsteosarcomaBones of lower extremityCatheter ablationMicrowavesTreatment outcomePostoperative complications
Publication Date：2014-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 272-276 )