Your treatment with the Orthopaedic Oncology Service could include surgery, radiation and chemotherapy or any combination of the three.
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Primary Malignant Tumors
Types of Treatment
The treatment for bone and soft tissue sarcomas has improved and there are many survivors. Previously, amputation was the only surgical option. Now we have limb-sparing procedures which involve resection (surgical removal of the tumor) and reconstruction with bone (allograft-cadaver bone), metal prosthesis (rods, total knee and hip joints) and possible extensive muscle and skin grafting. The primary goal of surgery is to completely and safely remove the tumor. Resections or amputations must remove the entire bone or soft tissue involved with the tumor, plus a certain amount of healthy tissue around the tumor called a margin. The pathologist assists your surgeon to determine if the margin is negative which means that it is likely that all the local tumor has been removed. If margins are positive, postoperative radiation therapy and/or a repeat excision is usually advised.
Surgery is usually scheduled one to three weeks after completion of preoperative chemotherapy to allow time for your blood counts to get better, and about two weeks after preoperative radiation therapy. Staging studies (plain films, bone, MRI, and CT scans) will be scheduled again before surgery to determine the effect of treatment on the tumor.
Common Surgical Procedures and Projected Length of Hospital Stay
Biopsy (Bone or soft tissue) The incisional or open biopsy is an inpatient procedure (usually home the next day) because of concerns about spread of tumor, hematoma, pain control and infection. Chemotherapy and other treatments may begin the next day. Needle biopsies are out-patient procedures done either in the office or under CT scan/ultrasound control.
Soft Tissue Tumors Resection of a benign soft tissue mass: one to two days in the hospital, three days for larger masses.
Wide resection of a malignant soft tissue mass (sarcoma): three to five days depending on the tumor size, location and other type of treatment received before surgery, such as chemotherapy or radiation therapy. Larger sarcomas may require five to seven days in the hospital.
Tumor bed excision: Many patients are referred to us with an incomplete excision of a malignant soft tissue mass that was done at another hospital. They usually require radiation treatment and a re-excision of where the tumor was, called the tumor bed (or vice versa). Length of stay, three to five days in the hospital.
Wide resection of a soft tissue sarcoma with need for a plastic surgeon to do a muscle flap and/or split thickness skin graft: seven, ten or fourteen days depending on the tumor size, location, and type of flap/graft.
Wide resection of a soft tissue sarcoma with need for a vascular surgeon to repair an artery/vein because the tumor was wrapped around the vessels: seven to ten days in the hospital.
Curettage (scraping out) of a benign bone tumor with cement or donor bone (allograft) packing with or without metal fixation (plate, screws, wires): two to four days in the hospital depending on the tumor size and extent of curettage. If bone from your hip is used for packing, it may be longer (three to five days).
Wide resection of a malignant bone tumor with (allograft) donor bone reconstruction: upper and lower extremities require about five to seven days in the hospital; pelvic and sacral procedures need seven, ten or fourteen days in the hospital depending on tumor size, location, and procedures done by other surgeons.
Wide resection of a malignant tumor bone with allograft and/or metal prosthesis: same as above.
Amputations: above the knee (AKA) amputations, below the knee (BKA) amputations, and upper extremity amputations need five to seven days in the hospital. Amputation of the leg through the hip joint (hip disarticulation) and amputation through the pelvis above the hip joint (external hemipelvectomy) need about ten to fourteen hospital days.
Additional surgeries are rare, however in the unlikely event of infection, fracture or bone nonunion (delayed healing), the following surgeries will resolve the minor problems.
Irrigation and debridement (I &D) of wound/allograft infections: require five to fourteen days in the hospital or longer if infection persists. Patients with wound infections are readmitted to the hospital for the I&D and intravenous antibiotics. A PICC line is placed in your arm before you go home so antibiotics can be given intravenously for about six weeks. A PICC line is an intravenous catheter threaded up your arm to a major central vein in your chest. This central vein can handle harsh antibiotics better than the smaller veins in your hand. Daily dressing changes and packing of an open wound may need to be done by the visiting nurses or the patient/family member who has been taught the procedure. Sometimes allografts are removed and replaced with antibiotic cement spacers to fight infection for a few months. The patient receives intravenous antibiotics at home. Eventually the spacer is removed and the extremity is reconstructed using a metallic prosthesis.
Open reduction with internal fixation (ORIF) for bone and allograft fractures: requires a three to four day hospital stay.
Bone grafting procedures using the patient's hip bone (iliac crest-autologous) or donor bone (allograft) to nonunion sites (areas not healing) at the allograft-host junction sites require about three to four days in the hospital.
Hardware revision for broken plates, screws, loose rods or total joints ranges from three to seven days in the hospital depending on the extent of the revision.